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NORTH CAROLINA 

REGISTER 



IN TfflS ISSUE 



EXECUTIVE ORDER 



IN ADDITION 

Voting Rights Act 



PROPOSED RULES 
Commerce 

Environment, Health, and Natural Resources 
Human Resources 
Justice 



*. 



CONa 

TITUl 



IH LIEGIBUS.. 
9 ALUS 



RRC OBJECTIONS 



CONTESTED CASE DECISIONS 



ISSUE DATE: February 1, 



995 CCD 

FEB 



:7 



190§ 



KATHMN1 a g'JSS.aff 
LAW !y:353L&&¥ 

Volume 9 • Issue 21 • Pages 1697 ~W$T* 



INFORMATION ABOUT THE NORTH CAROLINA REGISTER AND ADMINISTRATIVE COIM? f 



NORTH CAROLINA REGISTER 

The North Carolina Register is published twice a month and 
contains information relating to agency, executive, legislative and 
judicial actions required by or affecting Chapter 150B of the General 
Statutes. All proposed administrative rules and notices of public 
hearings filed under G.S. 1 50B-21 .2 must be published in the Register. 
The Register will typically comprise approximately fifty pages per 
issue of legal text. 

State law requires that a copy of each issue be provided free of 
charge to each county in the state and to various state officials and 
institutions. 

The North Carolina Register is available by yearly subscription at 
a cost of one hundred and five dollars ($105.00) for 24 issues. 
Individual issues may be purchased for eight dollars ($8.00). 

Requests for subscription to the North Carolina Register should be 
directed to the Office of Administrative Hearings, P. O. Drawer 27447, 
Raleigh, N.C. 2761 1-7447. 

ADOPTION, AMENDMENT, AND REPEAL OF 
RULES 

The following is a generalized statement of the procedures to be 
followed for an agency to adopt, amend, or repeal a rule. For the 
specific statutory authority, please consult Article 2 A of Chapter 150B 
of the General Statutes. 

Any agency intending to adopt, amend, or repeal a rule must first 
publish notice of the proposed action in the North Carolina Register. 
The notice must include the time and place of the public hearing (or 
instructions on how a member of the public may request a hearing); a 
statement of procedure for public comments; the text of the proposed 
rule or the statement of subject matter; the reason for the proposed 
action; a reference to the statutory authority for the action and the 
proposed effective date. 

Unless a specific statute provides otherwise, at least 15 days must 
elapse following publication of the notice in the North Carolina 
Register before the agency may conduct the public hearing and at least 
30 days must elapse before the agency can take action on the proposed 
rule. An agency may not adopt a rule that differs substantially from the 
proposed form published as part of the public notice, until the adopted 
version has been published in the North Carolina Register for an 
additional 30 day comment period. 

When final action is taken, the promulgating agency must file the 
rule with the Rules Review Commission (RRC). After approval by 
RRC, the adopted rule is filed with the Office of Administrative 
Hearings (OAH). 

A rule or amended rule generally becomes effective 5 business 
days after the rule is filed with the Office of Administrative Hearings 
for publication in the North Carolina Administrative Code (NCAC). 

Proposed action on rules may be withdrawn by the promulgating 
agency at any time before final action is taken by the agency or before 
filing with OAH for publication in the NCAC. 



TEMPORARY RULES 



! 



Under certain emergency conditions, agencies may issue te 
rary rules. Within 24 hours of submission to OAH, the Codif 
Rules must review the agency's written statement of findings of 
for the temporary rule pursuant to the provisions in G.S. 150B-2 
the Codifier determines that the findings meet the criteria in 
150B-21.1, the rule is entered into the NCAC. If the Co 
determines that the findings do not meet the criteria, the rule is reti 
to the agency. The agency may supplement its findings and resi 
the temporary rule for an additional review or the agency may res 
that it will remain with its initial position. The Codifier, thereaftei 
enter the rule into the NCAC. A temporary rule becomes effe 
either when the Codifier of Rules enters the rule in the Code or o 
sixth business day after the agency resubmits the rule without ch< 
The temporary rule is in effect for the period specified in the ruleo 
days, whichever is less. An agency adopting a temporary rule 
begin rule-making procedures on the permanent rule at the same 
the temporary rule is filed with the Codifier. 

NORTH CAROLINA ADMINISTRATIVE CODI 

The North Carolina Administrative Code (NCAC) is a compil 
and index of the administrative rules of 25 state agencies an 
occupational licensing boards. The NCAC comprises approxim 
15,000 letter size, single spaced pages of material of which appi 
mately 35% is changed annually. Compilation and publication o 
NCAC is mandated by G.S. 150B-21.18. 

The Code is divided into Titles and Chapters. Each state agen 
assigned a separate title which is further broken down by chap 
Title 21 is designated for occupational licensing boards. 

The NCAC is available in two formats. 

(1) Single pages may be obtained at a minimum cost of 
dollars and 50 cents ($2.50) for 10 pages or less, plus fif 
cents ($0.15) per each additional page. 

(2) The full publication consists of 53 volumes, totalin 
excess of 15,000 pages. It is supplemented monthly 
replacement pages. A one year subscription to the 
publication including supplements can be purchased 
seven hundred and fifty dollars ($750.00). Individual 
umes may also be purchased with supplement service, 
newal subscriptions for supplements to the initial publica 
are available. 

Requests for pages of rules or volumes of the NCAC shouli 
directed to the Office of Administrative Hearings. 

CITATION TO THE NORTH CAROLINA 
REGISTER 

The North Carolina Register is cited by volume, issue, p 
number and date. 1:1 NCR 101-201, April 1, 1986 refers to Voli 
1, Issue 1, pages 101 through 201 of the North Carolina Registeriss 
on April 1, 1986. 



FOR INFORMATION CONTACT: Office of Administra- 
tive Hearings, ATTN: Rules Division, P.O. Drawer 27447, 
Raleigh, North Carolina 2761 1-7447, (919) 733-2678. 



NORTH 
CAROLINA 
REGISTER 




Office of Administrative Hearings 

P. O. Drawer 27447 

Raleigh, North Carolina 27611-7447 

(919) 733-2678 



Julian Mann III, 

Director 
James R. Scarcella St., 

Deputy Director 
Molly Masich, 

Director ofAPA Services 



Staff: 

Ruby Creech, 

Publications Coordinator 
Teresa Kilpatrick, 

Editorial Assistant 
Jean Shirley, 

Editorial Assistant 

This publication is printed on permanent, 
acid-free paper in compliance with 
G.S. 125-11.13. 



ISSUE CONTENTS 



I. EXECUTIVE ORDER 

Executive Order 1697 

II. IN ADDITION 

Voting Rights Act 1700 

III. PROPOSED RULES 
Commerce 

Banking Commission 1701 

Environment, Health, and 
Natural Resources 

Wildlife Resources Commission . . 1854 
Human Resources 

Medical Care Commission 1718 

Justice 

Alarm Systems Licensing Board 1853 

TV. RRC OBJECTIONS 1856 

V. CONTESTED CASE DECISIONS 

Index to ALJ Decisions 1860 

Text of Selected Decisions 
93 OSP 1694 1875 

VI. CUMULATIVE INDEX 1879 







NORTH CAROLINA REGISTER 










Publication Schedule 












(November 1994 - September 1995) 














Earliest 


* End of 






Volume 
and 
Issue 

Number 


Issue 
Date 


Last Day 

for 

Filing 


Last Day 
for Elec- 
tronic 
Filing 


Date for 

Public 

Hearing 

15 days 

from 

notice 


Required 

Comment 

Period 

30 days 
from 
notice 


Last Day 

to Submit 

to RRC 


** Earliest 

Effective 

Date 


9:15 


11/01/94 


10/11/94 


10/18/94 


11/16/94 


12/01/94 


12/20/94 


02/01/95 


9:16 


11/15/94 


10/24/94 


10/31/94 


11/30/94 


12/15/94 


12/20/94 


02/01/95 


9:17 


12/01/94 


11/07/94 


11/15/94 


12/16/94 


01/03/95 


01/20/95 


03/01/95 


9:18 


12/15/94 


11/22/94 


12/01/94 


12/30/94 


01/17/95 


01/20/95 


03/01/95 


9:19 


01/03/95 


12/08/94 


12/15/94 


01/18/95 


02/02/95 


02/20/95 


04/01/95 


9:20 


01/17/95 


12/21/94 


12/30/94 


02/01/95 


02/16/95 


02/20/95 


04/01/95 


9:21 


02/01/95 


01/10/95 


01/18/95 


02/16/95 


03/03/95 


03/20/95 


05/01/95 


9:22 


02/15/95 


01/25/95 


02/01/95 


03/02/95 


03/17/95 


03/20/95 


05/01/95 


9:23 


03/01/95 


02/08/95 


02/15/95 


03/16/95 


03/31/95 


04/20/95 


06/01/95 


9:24 


03/15/95 


02/22/95 


03/01/95 


03/30/95 


04/17/95 


04/20/95 


06/01/95 


10:1 


04/03/95 


03/13/95 


03/20/95 


04/18/95 


05/03/95 


05/22/95 


07/01/95 


10:2 


04/17/95 


03/24/95 


03/31/95 


05/02/95 


05/17/95 


05/22/95 


07/01/95 


10:3 


05/01/95 


04/07/95 


04/17/95 


05/16/95 


05/31/95 


06/20/95 


08/01/95 


10:4 


05/15/95 


04/24/95 


05/01/95 


05/30/95 


06/14/95 


06/20/95 


08/01/95 


10:5 


06/01/95 


05/10/95 


05/17/95 


06/16/95 


07/03/95 


07/20/95 


09/01/95 


10:6 


06/15/95 


05/24/95 


06/01/95 


06/30/95 


07/17/95 


07/20/95 


09/01/95 


10:7 


07/03/95 


06/12/95 


06/19/95 


07/18/95 


08/02/95 


08/21/95 


10/01/95 


10:8 


07/14/95 


06/22/95 


06/29/95 


07/31/95 


08/14/95 


08/21/95 


10/01/95 


10:9 


08/01/95 


07/11/95 


07/18/95 


08/16/95 


08/31/95 


09/20/95 


11/01/95 


10:10 


08/15/95 


07/25/95 


08/01/95 


08/30/95 


09/14/95 


09/20/95 


11/01/95 


10:11 


09/01/95 


08/11/95 


08/18/95 


09/18/95 


10/02/95 


10/20/95 


12/01/95 


10:12 


09/15/95 


08/24/95 


08/31/95 


10/02/95 


10/16/95 


10/20/95 


12/01/95 


This table is pw 


ilished as a public service. 


and the computation of 


time periods are not to be deemed binding 


or controlling. 
6. 


Time is computed according to 26 NCAC 2B .0103 and the Rules of Civil Procedure, Rule 


* An agency r 


nust accept comments for at least 30 days after the proposed text is published or until the date 


of any public he 


aring, whichever is longer. 


See G.S. 150B-2 1.2(f) for adoption procedures. 




** The "Earlies 


t Effective Date " is computed assuming 


that the agency follows the publication schedule above, 


that the Rules R 


eview Commission approves the rule at 


the next calendar month meeting after submission, and 


that RRC delive 


•s the rule to the Codifier c 


f Rules five (5) business days before the 1st day of the next calendar 


month. 
















Revised 10/94 

















EXECUTIVE ORDER 



EXECUTIVE ORDER NO. 67 

EXTENSION OF EXECUTIVE 

ORDER NO. 1 

NORTH CAROLINA BOARD OF ETHICS 

Pursuant to the authority vested in me as Gover- 
nor by the Constitution and laws of North Caroli- 
na, IT IS ORDERED: 

Executive Order No. 1, North Carolina Board of 
Ethics, as amended by Executive Order No. 14, is 
hereby extended without amendment for two years. 

This Executive Order is effective immediately. 

Done in the City of Raleigh this the 6th day of 
January, 1995. 

EXECUTIVE ORDER NO. 68 

ESTABLISHING THE NORTH CAROLINA 

INFORMATION HIGHWAY COUNCIL OF 

ADVISORS AND THE NORTH CAROLINA 

INFORMATION HIGHWAY POLICY 

COMMITTEE 

WHEREAS, the successful implementation of the 
North Carolina Information Highway is critical to 
improving the economic vitality of the State 
through the employment of information technology 
for economic development and to enhancing the 
quality of life of all citizens, particularly in the 
delivery of health services, the education of its 
citizens, the training of its workforce, the provid- 
ing of greater public safety through the develop- 
ment of an integrated criminal justice information 
system, the offering of more integrated, effective 
and efficient services to citizens by state and local 
governments and the deployment of information 
technology to citizens utilizing our libraries as 
gateways; and 

WHEREAS, it is important that the North Caro- 
lina Information Highway be developed from a 
broad perspective utilizing the knowledge of a 
diverse group of citizens at the advisory level and 
a group of internal and external public officials as 
a policy committee. 

NOW, THEREFORE, by the power vested in me 
as Governor by the laws and Constitution of the 
State of North Carolina, IT IS ORDERED: 

Section 1. Establishment. 

The North Carolina Information Highway Coun- 
cil of Advisors and the North Carolina Information 



Highway Policy Committee are hereby established. 

Section 2. Definitions. 

For the purposes of this Executive Order, the 
following definitions apply: 

(A) The term "Council" means the North 
Carolina Information Highway Council of 
Advisors; 

(B) The term "Policy Committee" means the 
North Carolina Information Highway 
Policy Committee; 

(C) "North Carolina Information Highway" 
(NCIH) means the advanced telecommu- 
nications networks operating with high- 
speed increased capacity capabilities and 
any other voice, data, video, imaging or 
other network application that might be 
interoperable or interconnected with the 
North Carolina Information Highway. 

Section 3. Purpose and Intent. 

The purpose of the Council and the Policy 
Committee is to advise the Governor, the Informa- 
tion Resources Management Commission (IRMC), 
the North Carolina General Assembly and the 
Office of the State Controller on any matters 
pertaining to the NCIH. The Policy Committee 
shall also make such recommendations as it deems 
necessary to the Information Highway Grants 
Advisory Council. 

Section 4. Membership. 

A. The Council shall consist of 30 members. 
The Speaker of the House shall appoint 5 members 
and the President Pro Tem of the Senate shall 
appoint 5 members. The Governor shall request 
the Chair of the IRMC, the Chair of the North 
Carolina Utilities Commission, the Chair of the 
Policy Committee, the Chief Executive Officer of 
the Microelectronics Center of North Carolina 
(MCNC) and the State Controller to serve as ex- 
officio members of the Council. The Governor 
shall appoint the remaining 15 members of the 
Council, including the Chair. The appointing 
authorities shall consider interest in the State's 
telecommunications policies related to the ability 
of the State to provide responsive and cost-effec- 
tive services to its citizens. To the extent possible, 
efforts should be made to represent all geographic- 
al areas of the State. 

Of the Governor's appointees, six shall be 
professionals from private industry and shall be 
from the ranks of leaders in either the fields of 
information or telecommunications technology or 
senior business leaders with experience in applying 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1697 



EXECUTIVE ORDER 



these technologies and services on an enterprise- 
wide basis. These members shall also be available 
to serve as an additional advisory body for offer- 
ing expert guidance and counsel regarding the 
implementation, application and management of 
resources and services for information technology 
and telecommunications to the Governor, the State 
Controller and the IRMC, as was previously 
performed by the Governor's Committee on Data 
Processing. To augment this group for accom- 
plishing its expanded responsibilities, the State 
Controller may appoint up to four individuals from 
non-profit organizations, local or federal govern- 
ment agencies, universities or research institutions 
to serve with it when meeting as an additional 
advisory body. A member of the Council of 
Advisors shall be authorized to sit on the IRMC. 
This person should fill the seat formerly assigned 
to the Governor's Committee on Data Processing. 
The NCIH Council of Advisors shall meet at 
least twice yearly. They will work with the Policy 
Committee to involve the business, educational, 
and governmental communities and the citizens at 
large to understand the Information Highway, 
applications that can use these information net- 
works and their benefits to the State of North 
Carolina. 

B. Members of the Policy Committee and its 
Chair shall be appointed by the Governor. The 
Policy Committee shall be composed of individuals 
who represent agencies of the State of North 
Carolina including, but not limited to, representa- 
tives from the Council of State and Cabinet agen- 
cies, the University of North Carolina System, and 
the North Carolina Community College System. 
A staff member from the IRMC, a staff member 
from the State Controller's Office and two staff 
members of the MCNC Advanced Networking 
Group shall be appointed by the Governor. Repre- 
sentatives of public or private non-profits should 
be considered for membership. Membership on 
this Policy Committee should reflect the member- 
ship of the former NCIH Planning Committee. 
The Committee may form subcommittees as 
desired to help in the performance of its duties and 
responsibilities. 

The Policy Committee shall provide guidance 
and direction to the NCIH Council of Advisors. 
It shall use its experience and knowledge to pro- 
vide unified recommendations on NCIH future 
directions to the IRMC, to recommend proposed 
NCIH standards to the IRMC, to integrate applica- 
tions among agencies, to promote interoperability, 
and to coordinate integration efforts across state 
and local government agencies. 



The Policy Committee, the Office of t 
State Controller and the IRMC should wo 
closely together, particularly during the critic 
controlled introduction phase (five years) of t 
NCIH, when they should be in constant commui 
cation. To facilitate this, it is requested that t 
State Controller encourage his NCIH staff 
attend all meetings of the Policy Committee. T 
Office of the State Controller and the Informati< 
Resources Management Commission will contin 
to have the authority over telecommunicatio 
currently identified for each by the General Sfc 
utes of North Carolina. 

C. Members of the Council and the Poli 
Committee shall serve two-year terms. Vacanci 
shall be filled by the original appointing authori 
for the balance of the unexpired terms. 

D. A majority of the members of the Coum 
shall constitute a quorum for the transaction 
business of the Council. A majority of the mer 
bers of the Policy Committee shall constitute 
quorum for the transaction of business of tl 
Policy Committee. 

E. The Council members shall receive 
salary. Subsistence and travel expenses are avai 
able for those who could not serve without rein 
bursement, in accordance with the N.C.G.S. 121 
3.1, 138-5 and 138-6, as applicable. Members 
the General Assembly will be requested to u: 
their General Assembly funds to reimburse the; 
for their expenses. Policy Committee membe 
will receive any reimbursement from their respei 
tive agencies. 

F. The staff for the Council shall be the Polk 
Committee, staff for the Policy Committee shall 1 
provided by the Office of the Governor, the IRM 
and the Office of the State Controller. Sta 
entities who have members on the Policy Commi 
tee may be requested to provide some staff assi; 
tance to the Policy Committee. 

Section 5. Responsibilities. 

The NCIH Council and the Policy Commitfe 
shall file a report with the Governor, the IRM 
and the General Assembly by June 1995 an 
thereafter at least twice per year. The report ma 
make recommendations on the NCIH implement 
tion in the public high schools and elemental 
schools of North Carolina, the libraries, th 
criminal justice system, intergovernmental an 
economic development activities, health service 
delivery and any other recommendations the 
might choose to make about the planning impl 
mentation of the NCIH. Upon request, the Com 
cil shall also report to the Education Oversigl 



1698 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



EXECUTIVE ORDER 



Committee and any other General Assembly 
Oversight Committee. 

Section 6. Funding. 

Monies for the carrying out of this Executive 
Order shall come from the funds of the State 
already appropriated. The Council and the Policy 
Committee may also receive funds from other 
public and/or private for-profit and nonprofit 
foundations. 

Section 7. Effect on Other Executive Orders. 



All prior Executive Orders or portions of prior 
Executive Orders inconsistent herewith are rescind- 
ed. 

This order shall become effective immediately 
and remain in effect until rescinded. 

Done in the Capital City of Raleigh, North 
Carolina, this the 6th day of January, 1995. 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1699 



IN ADDITION 



1 his Section contains public notices that are required to be published in the Register or have beet 
approved by the Codifier of Rules for publication. 



U.S. Department of Justice 

Civil Rights Division 

DLP:MAP:RPR:tlb Voting Section 

DJ 166-012-3 P.O. Box 66128 

94-4340 Washington, DC. 20035-6128 

January 9, 1995 

Jesse L. Warren, Esq. 

City Attorney 

P. O. Box 3136 

Greensboro, North Carolina 27402-3136 

Dear Mr. Warren: 

This refers to the annexation (Ordinance No. 94-108) and the designation of the annexed area 
to District 2 of the City of Greensboro in Guilford County, North Carolina, submitted to the Attorney 
General pursuant to Section 5 of the Voting Rights Act of 1965, as amended, 42 U.S.C. 1973c. We 
received your submission on November 9, 1994. 

The Attorney General does not interpose any objection to the specified changes. However, 
we note that Section 5 expressly provides that the failure of the Attorney General to object does not 
bar subsequent litigation to enjoin the enforcement of the changes. See the Procedures for the 
Administration of Section 5 (28 C.F.R. 51.41). 



Sincerely, 

Deval L. Patrick 

Assistant Attorney General 

Civil Rights Division 



By: 



John K. Tanner 
Acting Chief, Voting Section 



7700 NORTH CAROLINA REGISTER February 1, 1995 9:21 



IN ADDITION 



TITLE 4 - DEPARTMENT OF 
COMMERCE 

Notice is hereby given in accordance with G.S. 
150B-21.2 that the North Carolina Banking Com- 
mission intends to adopt rules cited as 4 NCAC 
3C . 0112, .1701 -.1 705, .1801 - . 1802; amend 3C 
.0101, .0107, .0111, .0201 - .0204, .0301, .0801 - 
.0804, .0807, .0901, .1001, .1101 and .1301 - 
.1302. 

1 he proposed effective date of this action is June 
1, 1995. 

Ihe public hearing will be conducted at 9:00 
a.m. on March 3, 1995 at the Dobbs Building, 430 
North Salisbury Street, Room 6227, Raleigh, North 
Carolina. 

MYeason for Proposed Action: 
4 NCAC 3C . 0101 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. 

4 NCAC 3C .0107 - This amendment provides that 
bank certificates must be posted in plain view of its 
customers. 

4 NCAC 3C . 0111 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. 

4 NCAC 3C .0112 - This Rule establishes guide- 
lines for amendments to bank charters regarding 
director liability. 

4 NCAC 3C . 0201 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. In addition, it elimi- 
nates the requirement that the Commissioner of 
Banks publish in the newspaper a notice that a 
bank application was filed, and requires that 
branch certificates be posted in plain view of its 
customers. 

4 NCAC 3C .0202 - This amendment substitutes 
limited service facility for teller's window and 
distinguishes the physical location and mailing 
address of the Commissioner of Banks. 
4 NCAC 3C .0203 - This amendment provides the 
rule number that this rule references. 
4 NCAC 3C .0204 - This amendment eliminates 
ihe requirement that the Commissioner of Banks 
publish in the newspaper notice of a request for a 
branch to covert to a limited service facility. In 
addition, it distinguishes the physical location and 
the mailing address of the Commissioner of Banks. 



4 NCAC 3C . 0301 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. In addition, it elimi- 
nates the requirement that the Commissioner of 
Banks publish in the newspaper a notice of an 
application to change the location of a main office, 
branch, or limited service facility. 
4 NCAC 3C .0801 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. 

4 NCAC 3C .0802 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. In addition, it clari- 
fies which banks must have their proposed deposi- 
tories approved by the Commissioner of Banks. 
4 NCAC 3C .0803 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. 

4 NCAC 3C . 0804 - This amendment distinguishes 
the physical location and the mailing address of 
the Commissioner of Banks. In addition, it pro- 
vides that two different forms will be used for 
approval of a banks investment limitation and loan 
limitation. 

4 NCAC 3C .0807 - This amendment adds joint 
venture as one of the types of entities a bank may 
seek approval to invest in. 

4 NCAC 3C .0901 - This amendment increases the 
aggregate amount of direct and indirect liability 
from ten thousand dollars ($10,000) to twenty 
thousand dollars ($20,000) as being, the threshold 
amount for omitting the indirect liability ledger. 
4 NCAC 3C .1001 - This amendment changes the 
requirements for determining which borrowers 
must submit financial statements from those receiv- 
ing ten thousand dollars ($10,000) or more in 
unsecured loans to those receiving twenty thousand 
dollars ($20,000) or more in unsecured loans or 
extensions of credit. It sets out the form of the 
financial statements and provides two exceptions to 
the requirements of filing financial statements. In 
addition, this rule provides an alternative (real 
property tax notice) to obtaining a real estate 
appraisal and three acceptable approaches to 
determining the value of real property. 
4 NCAC 3C .1101 - This amendment provides 
definitions for terminology used in Rules .1102, 
.1103, .1104, and .1105. 

4 NCAC 3C .1301 - This amendment changes the 
required vacation period that banks must provide 
to its employees from six to five working days. 
4 NCAC 3C .1302 - This amendment establishes 
the conditions that must be met when a bank wants 
to establish a stock option or stock purchase plan 
for its directors, officers, and employees. It 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1701 



PROPOSED RULES 



provides the information to be provided when 
submitting a request for approval of the plan. In 
addition, it provides the limitation for the types of 
stock and number of shares to be issued under the 
plans. 

4 NCAC 3C .1701 - This rule provides the defini- 
tions of types of services that banks may establish 
pursuant to Rules .1702, .1 703, . 1 704, and . 1 705. 
4 NCAC 3C .1702 - This rule allows a nonresident 
bank to establish loan production offices in North 
Carolina. It indicates the activities or services 
that a nonresident bank may or may not participate 
in or provide. 

4 NCAC 3C .1703 - This rule allows a nonresident 
bank to establish lockbox services in North Caroli- 
na. It establishes the criteria a nonresident bank 
must meet as well as the activities that they may 
participate in. 

4 NCAC 3C .1704 - This rule allows a nonresident 
bank to establish a trust representative office in 
North Carolina. It indicates the activities and 
services that a nonresident bank may or may not 
participate in or provide. 

4 NCAC 3C .1705 - This rule allows a nonresident 
bank to establish a business development office in 
North Carolina. It indicates the activities and 
services that a nonresident bank may or may not 
participate in or provide. 

4 NCAC 3C .1801 - This rule allows a state bank 
to provide courier or messenger services to its 
customers pursuant to a written agreement. It also 
establishes the contents of the agreement. 
4 NCAC 3C .1802 - This rule sets out disclosure 
requirements for state banks providing courier or 
messenger services. 

{comment Procedures: Comments must be submit- 
ted in writing not later than Friday, March 3, 
1995. Written comments should be directed to: 
Garistine M. Davis, Counsel 
North Carolina Banking Commission 

P. O. Box 29512 
Raleigh, North Carolina 27626-0512. 

CHAPTER 3 - BANKING COMMISSION 

SUBCHAPTER 3C - BANKS 

SECTION .0100 - ORGANIZATION 
AND CHARTERING 

.0101 APPLICATION 

A new bank, industrial bank or trust company 
shall be incorporated and chartered in the manner 



prescribed in G.S. 53-2 through G.S. 53-8 and 
no other way. A charter application, on a for 
approved, together with a copy of the propos 
Articles of Incorporation and payment of tl 
prescribed fee, must be filed with The Commi 



sioner of Banks located at 430 North Salisbur 
Street, Dobbs Building. Suite 6210, Raleigl 
North Carolina 27611. The mailing address 
P.O. Box 29512, Raleigh, North Carolii 
27626-0512. 

Tho Commiooionar of Banks 

P.O. Box 29512 

Ral e igh, North Carolina 27626 0512. 

Statutory Authority G.S. 53-2; 53-92; 53-122(3). 

.0107 BANK CERTIFICATE 

Upon final action approving an application for 
new bank the Commissioner of Banks shall issu 
to the bank a Bank Certificate. A bank shall po; 
its Bank Certificate in plain view of its customei 
in its main office . A Form 45 is used for th; 
purpose and contains a certification that a 
statutory requirements have been satisfied and i 
an authorization to begin business. 



Statutory Authority G.S. 53-8; 53-92. 

.0111 NATIONAL BANK CONVERSION 

(a) A national bank may apply for authority t 
convert to a state bank An application fo 
conversion must be made on Form 30. Th 
application for conversion, together with a copy o 
the proposed articles of incorporation and paymer 
of the prescribed fee, must be filed with Th 
Commissioner of Banks located at 430 Nortl 



Salisbury Street. Dobbs Building, Suite 6210 
Raleigh, North Carolina 27611. The mailin 
address is PQ Box 29512. Raleigh, Norti 



Carolina 27626-0512. 

Th e Commission e r of Banks 

P.O. Box 29512 

Ral e igh, North Carolina 27626 0512. 

(b) Upon receipt of a copy of the articles o 
incorporation and the completed application fo 
conversion, the Commissioner will make ai 
examination into all the facts connected with th 
conversion. Following the completion of tha 
examination the Commissioner will issue a writtei 
decision approving or disapproving the application 

(c) Upon approval by the Commissioner o 
Banks, he will forward to the Secretary of Stafe 
for appropriate filing the articles of incorporatioi 
along with the certification of approval. Th« 
Commissioner will issue to the bank a Bank 



1702 



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February 1, 1995 



9:21 



PROPOSED RULES 



ertificate (Form 45) and any Branch Certificate 
Form 47) as needed. 

'tatutory Authority G.S. 53-2; 53-3; 53-4; 53-5; 
3-14; 53-104; 53-122(3). 

0112 ELIMINATION OF DIRECTOR 
LIABILITY 

(a) Bank charter amendments limiting director 
iability pursuant to G.S. 55-2-02(b)(3) must 



irovide that director liability is not eliminated or 



imited with regards to acts or omissions where the 



limination of personal liability of directors would 



)e contrary to the provisions of G.S. 53-1 et. seq. 

(b) A new bank, industrial bank, or trust 

-ompanv may submit proposed bank charter 



imendments to the Commissioner for review prior 



o an approval and giving the required notice to 
hareholders. 



Statutory Authority G.S. 53-104, 53-115, 55-202. 

SECTION .0200 - BRANCHES AND 
LIMITED SERVICE FACDLITDZS 

0201 ESTABLISHMENT OF BRANCHES 
AND LIMITED SERVICE 
FACDHTDZS 

Banks may establish branches or limited service 
acilities upon written approval of the 
Commissioner of Banks. 

(1) Application. An application to establish 
a branch bank or limited service facility 
must be submitted in writing on Form 
30. The application, together with the 
prescribed fee, must be filed with The 
Commissioner of Banks located at 430 
North Salisbury Street, Dobbs Building, 
Suite 6210, Raleigh, North Carolina 
276 1 1 . The mailing address is P.O. Box 
29512, Raleigh, North Carolina 
27626-0512. 

The Commission e r of Banks 

P.O. Box 29512 

Ral e igh, North Carolina 27626 0512. 

(2) Notice of filing of an application. Upon 
aoo e ptnno e of an application for filing, 
th e Commissioner of Banks will publish 
a notice of th e filing of the application in 
a n e wspap e r publish e d in th e oity, town 
or county where th e branch or limited 
s e rvic e facility is propos e d to b e located. 
A copy of th e notio e will bo mail e d 
Upon acceptance of an application for 
filing, the Commissioner of Banks will 



mail a notice of the filing of the 
application to each state-chartered bank 
operating a banking office in the 
community to be served by the proposed 
branch or limited service facility. A 
copy of the notice will be mailed to the 
Regional Administrator of National Banks 
for the National Bank Region for North 
Carolina. 

(3) Written comments. Any interested 
person may submit to the Commissioner 
of Banks written comments and 
information on an application within 14 
days after the notice has been published 
as provided in Paragraph (2) of this Rule. 
All written comments received during the 
comment period will become part of the 
official record compiled with respect to 
the application. The Commissioner of 
Banks may extend the comment period if 
he determines that there are extenuating 
circumstances. 

(4) Examination by Commissioner. Upon 
receipt of a completed application, the 
Commissioner of Banks will conduct an 
examination into all the facts connected 
with the establishment of a branch or 
limited service facility. 

(5) Action by Commissioner. No final 
decision may be made by the 
Commissioner of Banks until the 
comment period has expired. The final 
decision of the Commissioner of Banks 
on an application will be in writing and 
include findings of fact and conclusions 
of law. 

(6) Notification of Commissioner's action. 
The applicant and all persons who have 
made written requests for such notice will 
be given notice of the Commissioner of 
Banks' final decision on each application. 

(7) Request for review by Banking 
Commission. The applicant or any 
interested person may request the State 
Banking Commission to review the 
decision of the Commissioner of Banks 
with respect to an application to establish 
a branch or limited service facility within 
14 days from the time the Commissioner 
of Banks issues his written decision. The 
request for review must be in writing and 
must be sent to the address shown in 
Paragraph (1) of this Rule. 

(8) Review by Banking Commission. When 
requested by the applicant or any 



9:21 



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February 1, 1995 



1703 



PROPOSED RULES 



interested person, the decision of the 

Commissioner of Banks will be reviewed (2) 

at a public hearing by the State Banking 

Commission at its next regular or called 

meeting. Following the public hearing, 

the State Banking Commission will issue 

its final order approving, modifying or 

disapproving the decision of the 

Commissioner of Banks. Notice of the 

public hearing will be published in a 

newspaper published in the city, town or 

county where the proposed branch or 

limited service facility is to be located at 

least ten days prior to the scheduled 

hearing. (3) 

(9) Decision by Commissioner final. If there 
has been no written request for review 
within the 14-day period as provided in 
Paragraph (7) of this Rule, the decision 
issued by the Commissioner of Banks 
will become final with respect to the 
application. Upon final action approving 
an application for a new branch the 
Commissioner of Banks shall issue to the (4) 
branch or limited service facility a branch 
certificate which is to be posted in plain 

view of its customers. 

(10) Commissioner to set requirements. 
When a bank acquires one or more 
branches or limited service facilities in 
connection with a reorganization in which 

the Commissioner of Banks or other (5) 

depository financial institution regulator 
has found one or more depository 
financial institutions to be in an insolvent, 
unsafe or unsound condition, the 
Commissioner of Banks shall set all (6) 

requirements pertaining to notice and 
publication, time limitations, and any 
comment period. 

Statutory Authority G.S. 53-4; 53-14; 53-62; 
53-92. 

.0202 DISCONTINUANCE 

No bank may close a branch without the written 
approval of the Commissioner of Banks. 

(1) Procedure. The procedures provided in 
G.S. 53-62(e) must be followed in 
connection with any branch or t e ll e r's 
window closing any closing of a branch 
or limited service facility not subject to 
Rule .0203 of this Section. The required 
public notice to be published must be 
approved by the Commissioner of Banks 



prior to publication. 
Written comments. Any interest* 
person may submit to the Commission 
of Banks written comments ai 
information on an application 
discontinue within 14 days after the la 
notice has been published as required 1 
G.S. 53-62(e). All written commen 
received during the comment period wi 
become part of the official recoi 
compiled with respect to the applicatioi 
The Commissioner of Banks may extei 
the comment period if he determines th 
there are extenuating circumstances. 
Examination by Commissioner. Upo 
receipt of an application, th 
Commissioner of Banks will conduct a 
examination into all the facts connecte 
with the request to close a branch. Th 
Commissioner of Banks will hold 
public hearing as provided in G.S 
53-62(e) if there has been an appropriat 
request by an interested person. 
Action by Commissioner. No fin; 
decision may be made by th 
Commissioner of Banks until th 
comment period has expired. The fin 
decision of the Commissioner of Bank 
on an application to discontinue will b 
issued in writing and include findings 
fact and conclusions of law. 
Notification of Commissioner's action 
The applicant and all persons who haw 
made written requests for notice will b< 
given notice of the Commissioner o 
Banks' final decision on each application 
Request for review by Banking 
Commission. The applicant or any othe 
interested person may request the Stab 
Banking Commission to review th 
decision of the Commissioner of Banks 
with respect to an application 
discontinue a branch within 14 days fron 
the time the Commissioner of Banks 
issues his written decision. The reques 
must be in writing and sent to Th 
Commissioner of Banks, P.O. Bo; 

Carolin; 



29512. Raleigh. 
27626-0512 which 



North 



is 



located at 43C 



North Salisbury Street, Dobbs Building 
Suite 6210, Raleigh, North Carolina 
27611. 
Th e Commission e r of Banks 
P.O. Box 29512 
Ral e igh, North Carolina 27626 0512. 



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9:21 



PROPOSED RULES 



(7) Review by Banking Commission. When 
requested by the applicant or by any 
interested person, the decision of the 
Commissioner of Banks will be reviewed 
at a public hearing by the State Banking 
Commission at its next regular or called 
meeting. Following the public hearing, 
the State Banking Commission will issue 
its final order approving, modifying or 
disapproving the decision of the 
Commissioner of Banks. Notice of the 
public hearing will be published in a 
newspaper published in the city, town or 
county where the branch is to be 
discontinued at least ten days prior to the 
scheduled hearing. 

(8) Decision by Commissioner final. If there 
has been no written request for review 
within the 14-day period as provided in 
Paragraph (6) of this Rule, the decision 
issued by the Commissioner of Banks 
will become final with respect to the 
application to discontinue. 

(9) Commissioner to set requirements. 
Where a bank discontinues one or more 
branches in connection with a 
reorganization in which the 
Commissioner of Banks or other bank 
regulator has found one or more banks to 
be in an insolvent, unsafe, or unsound 
condition, the Commissioner of Banks 
shall set all requirements pertaining to 
notice and publication, time limitations, 
and any comment period. 

Statutory Authority G.S. 53-4; 53-62; 53-92. 



0203 DISCONTINUANCE OF A 

LIMITED SERVICE FACILITY 

(a) A bank may close a limited service facility 
ipon 30 days written notice to the Commissioner 
if Banks at the address set forth in Paragraph (1) 
if Rule .0201 of this Section , provided that the 
acility has not within a five year period 
mmediately proceeding the proposed date of 
losing operated as a branch bank. If the limited 
ervice facility which the bank proposes to close 
las operated as a branch bank within a five year 
>eriod immediately proceeding the proposed 
ilosing date, then the procedure set forth in 4 
•JCAC 3C .0202 must be followed. 

(b) For the purpose of this Rule, any bank and 
>ffice approved as a "teller's window" prior to 
uly 1, 1989, is considered and will be treated as 
i limited service facility. 



Statutory Authority G. S. 53-62. 

.0204 CONVERSION OF BRANCH 

TO LIMITED SERVICE FACILITY 

(a) A bank may convert a branch to a limited 
service facility upon written approval of the 
Commissioner of Banks. 

(b) (^Procedure. Any bank desiring to convert 
an existing branch to a limited service facility must 
apply in writing for authority to do so from the 
Commissioner of Banks and pay the prescribed 
fee. The letter must identify the name and 
location of the branch to be converted, the reason 
for the conversion, the services presently offered 
at the branch, and the services that will be 
discontinued upon conversion. 

(c) {2) Publication. Upon r e ceipt of a written 
requ e st for authority to convert a branch to a 
limited service facility, the Commi ss ion e r of Banks 
will publish onoo a week for two oons e outiv e 
woelcfl in a n e wspap e r publish e d in th e city, town 
or county in whioh the branch to b e convert e d is 
located, a public notic e of th e r e qu e st to convert. 
T-hM — publication — must — inolud e th e — nam e — and 
looation of th e branch to b e conv e rt e d, and must 
id e ntify th e s e rvic e s pr e s e ntly off e r e d at th e branch 
that will b e discontinu e d upon conv e rsion. Public 
notice as required by G.S. 53-62(e) must be given 
in connection with the conversion of a branch to a 
limited service facility. The required public notice 
to be published must be a pproved by the 
Commissioner of Banks prior to publication. The 
publication shall include: 

(1) the name and location of the branch to 
be converted; 

(2) the services presently offered at the 
branch that will be discontinued upon 
conversion. 

(d) {3)Written comments. Any interested person 
may submit to the Commissioner of Banks written 
comments and information on an application to 
convert a branch to a limited service facility within 
14 days after the last notice has been published 
pursuant to Paragraph (2) of this Rule. All written 
comments received during the comment period will 
become part of the official record compiled with 
respect to the application. The Commissioner of 
Banks may extend the comment period if he 
determines that there are extenuating 
circumstances. 

(e) ^Examination by Commissioner. Upon 
receipt of an application to convert, the 
Commissioner of Banks will conduct an 
examination into all the facts connected with the 
conversion of a branch. The Commissioner of 



h21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1705 



PROPOSED RULES 



Banks will hold a public hearing if there has been 
an appropriate request by an interested person. 

(f) 0)Action by Commissioner. No final 
decision may be made by the Commissioner of 
Banks until the comment period has expired. The 
final decision of the Commissioner of Banks on a 
request to convert a branch to a limited service 
facility will be issued in writing and include 
findings of fact and conclusions of law. 

(g) (^Notification of Commissioner's Action. 
The applicant and all persons who have made 
written requests for notice will be given notice of 
the Commissioner of Banks' final decision on each 
application. 

fh) f7-)Request for Review by Banking 
Commission. The applicant or any other interested 
person may request the State Banking Commission 
to review the decision of the Commissioner of 
Banks with respect to an application to convert a 
branch to a limited service facility within 14 days 
from the time the Commissioner of Banks issues 
his written decision. The request must be in 
writing and sent to The Commissioner of Banks, 
P.O. Box 29512, Raleigh, North Carolina 27626- 
0512 which is located at 430 North Salisbury 
Street, Dobbs Building, Suite 6210, Raleigh. 
North Carolina 27611 . 

Th e Commissioner of Bonks 

P.O. Box 29512 

Ral e igh, North Carolina 27626 0512. 

fi) (^Decision by Commissioner Final. If there 
has been no written request for review within the 
1 4-day period as provided in Paragraph (7) of this 
Rule, the decision issued by the Commissioner of 
Banks will become final with respect to the request 
to convert. 

Statutory Authority G.S. 53-62; 53-92; 53-122(3). 

SECTION .0300 - CHANGE OF 
LOCATION 

.0301 CHANGE OF LOCATION OF 
MAIN OFFICE, BRANCH OR 
LTD SVC FACILITY 

No bank may change the location of a branch, 

limited service facility or main office without the 

written approval of the Commissioner of Banks. 

(1) Application. Applications must be in the 

format required and filed, together with 

the prescribed fee, shall be filed wife 

The Commissioner of Banks located at 

430 North Salisbury Street, Dobbs 

Building, Suite 6210, Raleigh, North 

Carolina 27611. The mailing address is 



P.O. Box 29512, Raleigh. Nort 

Carolina 27626-0512. 

Th e Commissioner of Banks 

P.O. Box 29512 

Raleigh, North Carolina 27626 0512 

(2) Notice of filing of an application. Upo 

acceptance of an application for filing 

the Commissioner of Banks will publi s 

a notic e of th e filing of the application 



a n e wspap e r publish e d in the city, tow 
ef — oounty wh e r e th e branoh, — limite 



s e rvic e facility or main office is to b 



locat e d. — A copy of th e notice will b 



mail e d mail a notice of the filing of th 
application to each state-chartered ban 
operating a banking office in th 
community served by the branch, limita 
service facility or main office. A copy 
the notice will be mailed to the Regiona 
Administrator of National Banks for th 
National Bank Region for Nortl 
Carolina. 

(3) Written comments. Any intereste< 
person may submit to the Commissione 
of Banks written comments an< 
information on an application within 1 
days after the notice has been publishe< 
as provided in Subparagraph (2) of thi 
Rule. All written comments receive* 
during the comment period will becomi 
part of the official record compiled witl 
respect to the application. Thi 
Commissioner of Banks may extend thi 
comment period if he determines tha 
there are extenuating circumstances. 

(4) Examination by Commissioner. Upoi 
receipt of a completed application fo 
relocation the Commissioner of Bank 
will conduct an examination into all th< 
facts connected with the change o: 
location. 

(5) Action by Commissioner. No fina 
decision may be made by th< 
Commissioner of Banks until thi 
comment period has expired. The fina 
decision of the Commissioner of Bank 
on an application will be issued ii 
writing and will include findings of fee 
and conclusions of law. 

(6) Notification of Commissioner's action 
The applicant and all persons who hav 
made written request for notice, will be 
given notice of the Commissioner ol 
Banks' final decision on each application 

(7) Request for review by Banking 



1706 



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February 1, 1995 



9:21 



PROPOSED RULES 



Commission. The applicant or any 
interested person may request the State 
Banking Commission to review the 
decision of the Commissioner of Banks 
with respect to an application to relocate 
a branch, limited service facility or main 
office within 14 days from the time the 
Commissioner of Banks issues his written 
decision. The request for review must be 
in writing and must be sent to the address 
shown in Subparagraph (1) of this Rule. 

(8) Review by Banking Commission. When 
requested by the applicant or any 
interested person, the decision of the 
Commissioner of Banks will be reviewed 
at a public hearing by the State Banking 
Commission at its next regular or called 
meeting. Following the public hearing, 
the State Banking Commission will issue 
its final order approving, modifying or 
disapproving the decision of the 
Commissioner of Banks. Notice of the 
public hearing will be published in a 
newspaper published in the city, town or 
county where the branch, limited service 
facility or main office is to be located at 
least ten days prior to the scheduled 
hearing. 

(9) Decision by Commissioner final. If there 
has not been a written request for review 
within the 14-day period as provided in 
Subparagraph (7) of this Rule, the 
decision issued by the Commissioner of 
Banks will become final with respect to 
the application. 

Statutory Authority G.S. 53-62; 53-92; 53-122(3). 

SECTION .0800 - MISCELLANEOUS 
REPORTS AND APPROVALS 

0801 OATH OF DIRECTORS 

Form 2 incorporates a statutory oath required to 
be executed by each director of a state bank. The 
form requires the signature under oath of each 
director and his address. It must be executed in 
duplicate annually within 30 days after the election 
of a director. The forms can be obtained from and 
one copy must be filed with The Commissioner of 
Banks located at 430 North Salisbury Street, 



Dobbs Building, Suite 6210, Raleigh, North 



Carolina 27611. The mailing address is P.O. Box 



29512. Raleigh. North Carolina 27626-0512. -: 
Th e Commiooion e r of Banks 
430 N. Salisbury Street 



Dobbo Bldg. Box 29512 
Raleigh, N.C. 29626 0512 

Statutory Authority G.S. 53-80; 53-81; 53-92. 

.0802 DEPOSITORY BANKS 

Form 3 contains a request to the Commissioner 

of Banks to approve the proposed depositories of 

a bank for those banks not subject to the Federal 

Reserve Board's Regulation D codified at 12 

C.FR. 204 . It is required to be filed in duplicate 

annually by the Board of Directors of each state 

bank. The form may be obtained from and shall 

be filed with The Commissioner of Banks located 

at 430 North Salisbury Street, Dobbs Building, 

Suite 6210. Raleigh. North Carolina 27611. The 

mailing address is P.O. Box 29526-0512. 

Th e Commissioner of Banks 

4 30 N. Salisbury Str ee t 

Dobbs Bldg. Box 29512 

Raleigh, N.C. 29626 0512 

Statutory Authority G.S. 53-84; 53-92. 

.0803 OTHER REAL ESTATE 

Form 16-A contains a request for the 
Commissioner of Banks to approve holding for one 
year real estate acquired by foreclosure, etc., that 
had not been disposed of by the end of the 
previous year. It is required to be filed in 
duplicate annually by the Board of Directors of 
any state bank owning such real estate. The form 
may be obtained from and shall be filed with The 
Commissioner of Banks located at 430 North 
Salisbury Street, Dobbs Building, Suite 6210, 
Raleigh, North Carolina 27611. The mailing 
address is RO Box 29512, Raleigh, North 
Carolina 27626-0512. 

Th e Commission e r of Banks 

4 30 N. Salisbury Str ee t 

Dobbo Bldg. Box 29512 
Raleigh, N.C. 29626 0512 

Statutory Authority G.S. 53-43-(3)c; 53-92. 

.0804 SUSPENSION OF INVESTMENT 
AND LOAN LIMITATION 

Form 17 and Form 18 contains contain a request 
for the Commissioner of Banks to approve the 
suspension of a bank's investment limitation and ©f 
its loan limitation^ respectively, to a particular 
borrower for a period of 120 days. The form 
incorporates the required resolution of the bank's 
board of directors and must be accompanied by 
financial statements of the borrower(s) and must be 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1707 



PROPOSED RULES 



filed in triplicate. This report and the information 
contained therein is confidential and neither the 
report nor any of its contents shall be made 
available to the public. The form may be obtained 
from and filed with The Commissioner of Banks 
located at 430 North Salisbury Street, Dobbs 
Building, Suite 6210, Raleigh, North Carolina 
26711. The mailing address is RQ Box 29512. 
Raleigh, North Carolina 27626-0512. 
Tho Commiooion e r of Banks 

4 30 N. Saliobury Str ee t 

Dobbo Bldg. Box 29512 
Raloigh, N.C. 29626 0512 

Statutory Authority G.S. 53-49; 53-92; 53-99. 

.0807 SUBSIDIARY INVESTMENT 
APPROVAL 

Banks that desire to create or invest in a 
corporation, partnership, firm^ joint venture or 
other company entity which will engage in a 
nonbanking function and which shall be either 
partially or wholly owned by the bank must first 
obtain the approval of the Commissioner of Banks. 
The application for approval shall be by letter 
which must include the following: 

(1) A copy of the articles of incorporation, 
articles of partnership or other instrument 
creating or governing the business entity; 

(2) A description of the proposed activities 
and by whom these activities will be 
conducted; 

(3) The proposed investment in the enterprise 
expressed both in dollar amount and as a 
percentage of the bank's unimpaired 
capital funds; 

(4) The amount of the bank's investment in 
all existing subsidiaries, partnerships and 
companies as of the date of the letter of 
application; 

(5) The amount of the bank's unimpaired 
capital fund on the date of the letter of 
application as the same is defined at G.S. 
53-1(9); 

(6) A copy of any contract or agreement for 
a lease, rental or other commitment by 
the enterprise that would create a 
contingent liability upon the business (or 
enterprise) or the bank; 

(7) Copies of any licenses or other permits 
which the enterprise or its employees are 
required to obtain prior to engaging in a 
regulated activity. If such licenses are 
not available on the date of the letter of 
application the same must be submitted 



prior to final approval; and 
(8) The application fee as determined by < 
NCAC 3C .1601(a)(8). 

Statutory Authority G.S. 53-47; 53-104. 

SECTION .0900 - OPERATIONS 

.0901 BOOKS AND RECORDS 

Each bank, or its parent holding company, shal 
keep in permanent form, and available for exami 
nation by the representatives of the Commissione 
of Banks, books and records which reflect all th 
transactions of the bank in its true financial condi 
tion. Such records shall be so kept as to permi 
and facilitate a speedy examination, which will, h 
turn, reflect such financial condition to the repre 
sentatives of the Commissioner of Banks. Withou 
implying that these are the only books and record; 
to be kept, but, on the contrary, that these an 
necessary books and records, as well as othei 
books and records usually kept, the following art 
required to be kept at the bank, or at its parent 
holding company, unless another storage site is 
approved by the Commissioner of Banks: 
(1) Each commercial bank or branch thereof 
in which notes or other forms of similar 
obligations are retained must keep an 
alphabetical liability ledger. The direct 
liability ledger must be kept in balance 
with the general ledger control. In a 
commercial bank whose automated record 
system is not able to produce an alpha- 
betical liability ledger the bank must be 
able to produce an alphabetical listing of 
borrowers showing all of a customer's 
loan or customer account numbers and 
the amount outstanding under each num 
ber when called upon by the Commis- 
sioner of Banks or his duly authorized 
agent. In addition to the direct liability 
ledger, each commercial bank or branch 
thereof in which notes or other forms of 
similar obligations are retained must keep 
an alphabetical indirect liability ledger 
showing a customer's indirect obligations 
by loan name or account number and the 
balance outstanding under each account. 
Where the total of the direct and indirect 
lines do not exceed ten thousand dollars 
($10,000) twenty thousand dollars 



($20,000) , the indirect line may be 
omitted from the indirect liability ledger. 
The indirect liability ledger must be 
updated at least monthly. Each 



1708 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



commercial bank shall have the ability to 
produce both the direct and indirect 
liability ledgers in hard copy form upon 
call by the Commissioner of Banks or his 
duly authorized agent. 

(2) Records must be kept, showing the 
monthly reconciliation of each account 
with correspondent banks. A signed 
review of such reconciliations must be 
made by some officer or employee of the 
bank other than the person composing 
same. 

(3) A permanent record must be kept of all 
stocks and bonds bought or sold. Also, 
there must be retained for review by 
examiners all original invoices of 
purchases and sales of securities. The 
record must show dates of purchases and 
sales, interest rates, maturities, par value, 
cost value, all write-ups or write-downs, 
a full description of the security, from 
whom purchased, to whom sold, selling 
price, and when, where and why pledged 
or deposited. This record must be 
maintained in balance with the general 
ledger control. 

(4) A permanent record must be kept of all 
articles deposited for safekeeping. 
Receipts must be given and taken for all 
articles deposited or delivered. An 
inventory of parcels is not required. 

(5) A permanent record must be kept of all 
items charged off. All charge-offs must 
be authorized or approved by the 
executive committee or by the board of 
directors and such action recorded in 
their minutes. This record, among other 
things, must show the date of the 
charge-off, a description of the asset and 
the amount. The record must be 
supported by the actual charged off 
items, or the final disposition of any 
item. In this record must also be 
recorded all recoveries, giving dates and 
amounts. 

(6) A real estate record must be kept on all 
parcels owned, including the banking 
house. This record must show when, 
from whom, and how the property was 
acquired; date, cost price, book value, 
detailed income and detailed expenses. 
This record should be supported by 
appraisals, title certificates showing 
assessed value, tax receipts, and 
insurance policies. 



(7) Proper minutes, showing clearly its 
action, must be kept for each committee, 
board of directors, board of managers, 
and stockholders' meetings. All minutes 
must be signed by the chairman and the 
secretary of this meeting. 

(8) A permanent daily record must be kept of 
all cash items held over from the day's 
business, including all checks that would 
cause an overdraft if handled in the 
regular way. This record must show the 
name of the account on whom the item is 
drawn or is obligated for payment, the 
reason the item is being held, the date the 
item was placed in the cash items 
account, and the amount of the item. 
This record must be a daily record 
showing only those items held over at the 
end of each day's business and be kept in 
balance with the general ledger or control 
figure. 

(9) A detailed record of income and expenses 
must be kept, balanced monthly, and a 
report thereof made to the executive 
committee or board of directors, and the 
receipt of same noted in their minutes. 

(10) In the discretion of the Commissioner of 
Banks, he may require the preparation or 
maintenance of further books or records 
by specific banks or branches thereof. 

(11) Each industrial bank, when preparing a 
report of condition and income, must 
include and make a part of this report a 
list of those whose obligations to the 
bank, whether the obligations are direct 
or indirect, and including paper 
purchased by the bank, are in excess of 
ten percent of capital, surplus and 
undivided profits. In lieu of this list, the 
bank must maintain a liability ledger in 
accordance with Subsection (1) of this 
Rule. Any commercial bank making 
installment loans may, with reference to 
such installment loans, make the report 
specified in this section in lieu of the 
liability ledger required under Subsection 
(1) of this Rule. 

Statutory Authority G.S. 53-92; 53-110. 

SECTION .1000 - LOAN 
ADMINISTRATION AND LEASING 

.1001 LOAN DOCUMENTATION 

Each bank or bmnoh thereof wh e r e notes are 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1709 



PROPOSED RULES 



r e tain e d must havo tho following information s 

fl-) Current finanoial statements, datod within 

th e pr e ceding 1 8 months, and prop e rly 
certifi e d, — muat b e on fil e from thos e 
dir e otly liable to th e bank in an amount 
of ton thousand dollars ($10,000.00) or 
mor e , whioh obligations are uns e cur e d, 
te — the — extent of t e n thousand dollars 
($10,000.00), — ef — s ecur e d — ealy — by 
endorsements. — This appli e s, also, to th e 
endorser wh e r e ouoh e ndors e ments ar e 
th e basis of oredit. 

(3) This Subpart do e s not apply to loans 

s e cur e d by real prop e rty: 

(a) A writt e n appraisal of all collat e ral to 

loans must be made by th e e x e cutiv e 
committe e or loan committe e of th e 
bank — ef — branch, — ef — oth e r — reliable 
persons familiar with th e valu e of th e 
collateral, and must b e k e pt on fil e 

wh e r e — tee — eete — is — lodg e d. AH 

appraisals must b e r e n e w e d e v e ry 12 
months, exc e pt as r e quir e d in (2)(d) of 
this Rul e . 

{¥) The appraisal must inolud e : 

fi) nam e of borrower, 

{h) — dat e mad e , 
{in) — valu e of collat e ral, 
(fv) — signatures of at l e ast two — p e rson s 
making — the — appraisal — e xc e pt — as 
permitted in (2)(o) of this Rul e , 
(¥) — bri e f d e scription of oollnt e rnl, 
(vi) — amount of prior li e n, 

(vii) original amount — ef — outstanding 

balanc e of th e loan. 

{e) No appraisal is r e quir e d: 

{i) on collat e ral to not e s of l e ss than 

twenty thousand dollars ($20,000.00): 

(ii) — on loans fully s e cur e d by obligations 

of th e Unit e d Stat e s or th e Stat e of 

North Carolina; 

{«*) — on loans fully s e cur e d by d e posits in 

th e bank making th e loan; 
(i¥) — on loans fully secur e d by th e cash 
surr e nd e r — ef — leas — valu e — ef- — life 
insuranc e polici e s; 
(v) — ea — loons fully secur e d by bonded 
warehouse rec e ipts; 
-en — loans — fetty — s e cur e d — by — li s ted 



H>- 



securitios, — unless — seen — loans — afe 
within th e provisions of th e S e curities 
Exohango Aot of 193 4 as defin e d by 
R e gulation "U," as am e nd e d, of the 
Board of Gov e rnors of tho Federal 
R ese rv e System; On a loan of this 



typo, an appraisal must be mado cm 



k e pt on fil e until th e loan is paid; 
(vii) on floor plan loans to d e alers fue 



s e cur e d by sew automobil e s 



stationwagons, vans, and truoks; 
(viii) on — discount e d — notes — fef — a — eaak 



wh e r e — the — nete — is — giv e n — as — tk 



purchas e — prioe — ef- — an — automobik 



t e l e vision s e t, washing maohino, & 



prop e rty of a like oharaotor. 
{4) Appraisals — need — net — be — renowa 



annually r 



{i) whore an automobil e , stationwagon 

or housotrail e r is th e sol e collateral t < 



a loan; 



(«) — wh e re a truck or van not e xcoodinj 
8,000 pounds e mpty w e ight is the sol . 



collat e ral to a loan. 
{e) Appraisals may b e s ign e d by only 



e& 



p e rson: 



{*) wh e r e an automobile or stationwagoi 



is th e sol e collateral to a loan; 



{h) — whore a truok or van not e xcoodinj 
8,000 pound s e mpty w e ight is tho sol( 



collat e ral to a loan. 



(3) All r e al e stat e giv e n as security to loam 

of twenty thousand dollars ($20,000.00 



or over, wh e th e r directly or indirootl; 
pledged, must be apprai se d e ither by tw 
members — ef- — the — e x e cutiv e — ef — leas 



oommitte e who ar e familiar with roa 



e stat e values in the community wher e th « 
property — is — locat e d, — or by two ban! 



employees who ar e familiar with r e a 



estate valu e s in th e oommunity where th t 



prop e rty is — looat e d and who are no 
involv e d in th e loan transaction s e ourec 



by — tee — property — b e ing — apprais e d, — e 
singularly by a State lio e ns e d r e al e state 



appraiser — ef — Stat e certified — real — estate 
apprai se r or a p e rson c e rtified as a r e a 



e stat e apprais e r by — an appraisal trad' 



organizat ion: Th e p e rson making ai 



appraisal as provid e d by this Rulo muo 
b e sel e ct e d by th e bank. — Tho appraisa 



mu s t b e independ e nt in that tho appmis e i 
is not involv e d in th e loan tmnsaotioi 



s e our e d by th e prop e rty boing apprai oe c 
and — has — ee — int e rest, — finanoial — ef 



oth e rwis e , in th e prop e rty. Tho appraisa 



mu s t b e in writing, must bo dated, mue 

-tfrk 



-Hi- 



be sign e d as r e quir e d 

Subparagraph by the p e rson(s) making 



tho appraisal, and b e on file with tho loon 



docum e nts. — Th e appraisal must state th e 



1710 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



booio or approach used to d e t e rmin e -the 
value of the prop e rty. — A bank's appraioal 
form muot identify th e loan transaction 
for whioh the appraisal was mad e , th e 
current balano e of prior li e ns, — if any, 

disolos e d by the attorn e y's title 

certificat e , s e gr e gat e values ef- 

improv e monto from valu e s of land, and 
dosoribo th e prop e rty so it may bo easily 

identifi e d. If a prof e ssional appraisal 

form io us e d whioh do e s not have all of 

the r e quir e d information m — this 

Subparagraph, th e bank must compl e t e 
and attaoh its own appraisal form, sign ed 
by one of its e mployees, to the outsid e 
appraisal r e port di s olosing th e requir e d 
informatioR r 

{A) For loans s e cured by real prop e rty, a 

o e rtifioat e — ef- — title — furnish e d — by — a 
comp e t e nt — attorn e y — at — law — of — title 
insurance issued by a company lic e ns e d 
by the Commission e r of Insuranc e must 
accompany — e ach — deed — ef — trust — ef 
mortgag e giv e n as s e curity on loan s of 
tw e nty — thousand dollars — ($20,000) or 
ov e r. — Provided that any loan whioh is 
ba se d — primarily — en — the — borrower's 
g e n e ral — cr e ditworthiness — and — projected 
inoom e , wh e th e r or not aooompani e d by 
a d ee d of trust or mortgag e , — is — net 
consid e r e d — a — lean — s e cur e d — by — real 
prop e rty, and th e first s e nt e nc e of this 
Subparagraph shall not apply to any suoh 

lOuQ . 

(§) Wh e r e — stook — o e rtifioat e s, — ef — similar 



(9- 



s e curiti e s, ar e aoo e pt e d as collat e ral to 
loans, e aoh o e rtifioate must be endorsed 
and witn e ssed in ink, or aooompani e d by 
a stook pow e r sign e d and witnessed in 
ink. Wh e r e suoh collateral is in the name 
of anoth e r, — oth e r than th e mak e r or 



e ndors e r of the not e , th e r e must b e on 
file in the bank writt e n authority from the 
owner permitting th e hypoth e cation of the 
collateral. 

Loans mad e dir e otly to corporations must 
be — support e d — by — c e rtifi e d — copi e s — ef 
r e solutions of the board of directors of 
th e corporation, authorizing the making 
of suoh loans. 
(?) Loans mad e directly to partn e rships must 



b e s upport e d by a d e claration by the 
partn e rs showing th e composition of th e 
partnership and unless all partn e rs sign 
the note, the authority of th e partner(s) 



e x e cuting the nete — te bifid the 

partnership . 
(8) Full orodit information on all unlist e d 

securiti e s, — new — own e d — ef — hereafter 

purchased or acquired, must be s ecured 

and k e pt on fil e in th e bank. 
Unless otherwise provided, each bank, or any 
branch thereof, where notes are held must maintain 
on file the appropriate supporting documents as 
follows: 



ill 



i£l 



£2} 



£3i 



la] 



Financial 
statements shall 



Statements. 



Financial 



be required from any 
borrower who is a maker, co-maker, 
guarantor, endorser or surety on any 
unsecured loans or other unsecured 
in an amount of 



extensions of credit 



twenty thousand dollars ($20,000.00) or 
more in the aggregate. Financial 
statements required by this Item shall: 
be signed or otherwise properly 
executed; 

be dated within 18 months preceding 
the origination date of the credit 
obligation; 

be renewed within 18 months after the 
date of the last financial statement on 
file; 

be addressed to, or made specifically 
for, the lending bank; and 
include such information as will 
adequately reflect the assets, liabilities, 
net worth and income of the borrower- 
Financial Statement Exceptions. A bank 
may waive the financial statement 
required by Item (1) of this Rule for 
credit granted under a credit card. 
Additionally, a bank may elect to 
substitute in the place of a current 
financial statement a current credit 
bureau report for consumer loans 
scheduled to be repaid in at least 
quarterly installments- 
Personal Property A ppraisals. Appraisals 
on personal property used as collateral 
for a loan shall be obtained and shall be 
completed as follows: 
Generally. Except as otherwise 

provided below, a written appraisal of 
personal property used to collateralize 
any loan must be made by the executive 
committee or loan committee of the 
bank, or any branch thereof, or other 
reliable persons familiar with the value 
of the property. Except as provided, 
all appraisals must be renewed every 12 



NORTH CAROLINA REGISTER 



February 1, 1995 



1711 



PROPOSED RULES 



months. 

(b) Requirements. The appraisal required 
by this Item must include: 

(i) the name of the borrower; 

(ii) the date the appraisal was made; 

(iii) the value of the collateral; 

(iv) the signatures of at least two persons 

making the appraisal; 
(v) a brief description of the property; 
(vi) the amount of any prior lien and 

holder of the lien, if any; and 
(vii) the original amount or outstanding 

balance of the loan which the property 

is used to secure. 

(c) Appraisal Exceptions. No appraisal 
shall be required under the following 
circumstances: 

(i) on collateral to notes of less than 

twenty thousand dollars ($20,000.00); 
(ii) on loans fully secured by obligations 

of the United States or the State of 

North Carolina; 
(iii) on loans fully secured by deposits in 

the bank maintaining the loan 

account; 
(iv) on loans fully secured by the cash 

surrender or loan value of life 

insurance policies; 
(v) on loans fully secured by bonded 



{vi} 



id} 



warehouse receipts; 
on floor plan loans to dealers fully 
secured by new automobiles, 
stationwagons, vans, and trucks; 
on discounted notes for a dealer 
where the note is given as the 
purchase price of an automobile or 
other consumer goods; or 
(viii) on loans fully secured by listed 
securities, unless such loans are 
within the provisions of the Securities 
Exchange Act of 1934 as defined by 
Regulation "U," as amended from 
time to time by the Board of 
Governors of the Federal Reserve 
System . On loans secured by such 
collateral, appraisal must be made and 
kept on file until the loan is fully 
paid. 
Renewal Exceptions. Appraisals need 
not be renewed annually where an 
automobile, stationwagon, mobile 
home, or where a truck or van not 
exceeding 8,000 pounds empty weight, 
is the sole or partial collateral for a 
loan. 



£§) 



Single Signature Exception- 
appraisal may be signed by only oi 
person where an automobil 



14} 



stationwagon, mobile home, or where 
truck or van not exceeding 8,0( 
pounds empty weight, is the sol 
collateral for a loan- 
Real Estate Appraisals. Unless otherwi; 



provided, all real estate taken as securil 



for loans shall be appraised in the fon 
and manner set forth in Sub-item (4)(; 
through (4)(c) of this Rule. In additioi 



the appraisal must be independent in thj 
the appraiser is not involved in the loa 
transaction secured by the property bein 



[a) 



appraised and has no interest, financial c 

otherwise, in the property. 
The bank may elect to waive th 
requirement for an appraisal of re< 
estate given as security for loans 
twenty thousand dollars ($20,000.00) c 



dollai 



ill 



less. Appraisals of real estate given i 

security for loans over twenty thousan 

dollars ($20,000.00), but not exceedin 

two hundred fifty thousand 

($250,000.00). whether directly 

indirectly pledged shall be prepared b 

any one of the following methods: 

Two members of the executive o 

loan committee who are familiar wit 

real estate values in the communis 



mi 



where the property is located. 
Two bank employees who are familia 
with real estate values in th 
community where the property i 
located, provided that one of the tw 
employees must not be involved in th 
loan transaction secured by th 
property being appraised, 
(iii) A state-licensed real estate appraise 



or state-certified real estate appraise 



£iy} 



or a person certified as a real estat 
appraiser by an appraisal trad 
organization approved by the bank t 
perform the appraisal. 
In lieu of an appraisal as provided b 
Sub-items (4)(a)(i) through (iii) of thi 
Rule, a bank may elect to accept 
bona fide copy of the most recent rea 
property tax notice from the ta 
administrator's office in the county ii 
which the property is located provide< 
that such notice states the assessed at 
valorem tax value of the real estate 
and any improvements thereon 



1712 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



separate from the personal property; 

and provided further, the loan officer 

shall include with the tax notice a 

memorandum to file that he or she 

has obtained the notice from the 

county tax administrator and is of the 

opinion that such notice accurately 

reflects the real property values. 

(b) Except as noted, a ppraisals required by 

Sub-item (4) (a") of this Rule shall be in 

writing, and signed and dated by the 

person or persons making the appraisal. 

Additionally, the appraisal must identify 

the loan transaction for which it was 

made, the current balance of prior lien 

and holder of the lien, if any, disclosed 

by the attorney's title certificate, 

segregate values of improvements from 

values of the land, and describe the 

property so as to make it easily 

identifiable. If a professional appraisal 

form is used which does not include 

this information, the bank must 

complete and attach to such a ppraisal 

its own appraisal form disclosing the 

required information. The appraisal 

must state the basis or a pproach used to 

determine the value of the property. 

Acceptable a pproaches to determining 

the value of real property are: 

£i) The current cost of replacing a 

property, less depreciation relating to 

deterioration in functional and 

economic obsolescence. 

(ii) The value indicated by recent sales of 

comparable properties in the market 

and other market factors such as 

listings and offers to sell. 

(iii) The value that the property's net 

earning power will support, based on 

a capitalization of net income. 

All real estate given as security to loans 

in an amount over two hundred fifty 

thousand dollars ($250.000.00), 

whether directly or indirectly pledged 

shall be a ppraised and such a ppraisal 

shall be subject to the provisions of 12 

C.F.R. 321.1 through 12 C.F.R. 323.7, 

which are herein incorporated by 

reference. Pursuant to G.S. 150B-21.6, 

any reference to 12 C.F.R. 323.1 

C.F.R. 323.7 shall 



fsi 



through 12 
automatically 



include any later 



(6} 



m 



m 



19} 



real property, a certificate of title 
furnished by a competent attorney at law 
or, title insurance issued by a company 
licensed by the Commissioner of 
Insurance, must accompany each deed of 
trust or mortgage given as security on 
loans of twenty thousand dollars 
($20,000.00) or more- 
Stock Certificate/Powers. Where stock 
certificates, or similar securities, are 
accepted as collateral to loans, each 
certificate must be endorsed and 
witnessed in ink, or accompanied by a 
stock power signed and witnessed in ink. 
Where such collateral is in the name of 
another, other than the maker or endorser 
of the note, there must be on file in the 
bank written authority from the owner 
permitting the hypothecation of the 
collateral. 

Corporate Resolutions. Loans made 
directly to corporations must be 
su pported by certified copies of 
resolutions of the board of directors of 
the corporation, authorizing the making 
of such loans. 

Partnership Declaration. Loans made 
directly to partnerships must be supported 
by a declaration by the partners showing 
the composition of the partnership and 
unless all partners sign the note, the 
authority of the partner(s) executing the 
note to bind the partnership. 
Unlisted Securities. Full credit 

information on all unlisted securities. 



now owned or hereafter purchased or 
acquired, must be secured and kept on 
file in the bank. 

Statutory Authority G.S. 53-92; 53-110. 

SECTION .1100 - CAPITAL 

.1101 DEFINITIONS; ISSUANCE OF 
CAPITAL NOTES AND 
DEBENTURES 



A bank 



may issu e long term (oapital) d e b e ntur e s 
and not e s only aft e r having first r e c e iv e d th e 
writt e n approval of th e Commission e r of Banks. 

For the purposes of this Section, the following 
definitions shall a pply: 

(1) Capital Note. Any unsecured note or 



15) 



amendments or additions to those rules- 
Certificate of Title. For loans secured by 



debenture issued by a bank that qualifies 
as capital pursuant to the provisions of 
G.S. 53-1(9). 



.21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1713 



PROPOSED RULES 



£2} 
ID 
£4) 

£5) 

£6} 

ID 



Convertible Debentures. A debenture 

which is convertible into the capital stock 

of the issuing bank. 

Debenture. An unsecured promise to pay 

issued under the terms of a deed of trust 

or indenture. 

Long-Term Note or Debentures. Any 

note or debenture having a maturity of 

more than seven years. 

Medium-Term Note or Debentures. Any 

note or debenture having a maturity of 

not less than one or more than seven 



years. 

Non-convertible Debentures. A 

debenture which may not be converted 
into the shares of the capital stock of the 
issuing bank. 

Subordinated debentures. Debentures 
which are subordinated to and junior in 
right of payment to a banker's obligations 
to its depositors, its obligations under 
banker's acceptances and letters of credit, 
its obligations to any Federal Reserve 
Bank and any similar obligations to its 
other creditors, which, in the event of 
insolvency, receivership, conservatorship, 
reorganization, readjustment of debt, 
marshalling of assets and liabilities or 
like proceedings, or in any liquidation or 
winding up of or relating to the bank, 
whether voluntary or involuntary, shall 
be entitled to be paid in ful] before any 
amount shall be made on account of the 
principal of, or premium, if any, or 
interest on the debentures or notes. 
(8) Unsubordinated Debentures. A bank 
may issue medium term or long term 
capital notes and debentures only after 
having first received the written a pproval 
of the Commissioner of Banks. 

Statutory Authority G.S. 53-43.4; 53-92; 53-104. 

SECTION .1300 - BANK PERSONNEL 

.1301 ANNUAL VACATION 

(a) Every bank or branch thereof, under the 
supervision of the Commissioner of Banks, must 
grant to each officer and employee an annual 
vacation period of at least six five working days. 
The annual vacation period must be granted on 
consecutive working days and each officer and 
employee must remain absent from his duties 
continuously throughout the vacation period. 
Provid e d, how e v e r, that any bank or branoh that 



remains olosod on Saturdayo and Sundayp mm 



grant to e aoh offio e r and e mploy ee an annw 



vaoation of at l e aot fiv e oonBooutivo working day 



This Rule shall not apply to any specifie 
individual, officer or employee or group or clas 
of officers or employees, upon application by an 
bank or branch thereof and with the approval 
the Commissioner of Banks. 

(b) This Regulation does not apply to thos 
officers and employees who have been in a bank 
employment for a period of less than one yea 
Neither does this Regulation apply to employees 
a bank's incorporated subsidiary when th 
employee does not perform any banking service 
or duties for the parent bank. 

Statutory Authority G.S. 53-92; 53-104. 



.1302 SHARE PURCHASE AND 
OPTION PLANS 

A stat e chart e r e d bank may e otablioh: 

{fy otook option plans for tho benefit of it 



dir e ctors, officers, e mployees, or any o 
these groups, and 



{2} stook puroha se plans for the benefit o 

offio e r s — aad — e mploy ee s — provided — tfe 



following conditions ar e m e t: 



(a) Th e bank must s ubmit a writt e n roquoa 

to the Commission e r which inolud e o oi 



incorporat e s by r e f e r e nc e th e following 

info rmation: 

(i) A draft of th e plan docum e nt, 

(ii) — A copy of th e propos e d notic e o: 



shar e hold e rs' — meeting, — proxy, — a» 
proxy s tat e m e nt, 



(iii) — T-be — number — ef- — authorized — btf 
unissu e d shar e s that will bo allocat e d 



to th e plan, 



(*v) — A copy of any proposed amendm e nts 
te — the — Articles — ef — Incorporation 



cr e ating authorized but unissued stook 



and e liminating pro omptivo righto no 
te — shar e s — r ese rv e d — und e r — a stook 



option or stook purohas e plan, and 



{v) — T-fee — number — ef — shar e s — ef- — steek 
outstanding at th e time tho request io 
mad e and tho numb e r of shares which 



hav e pr e viou s ly boon allooatod to any 
stock option or stook purohaso plan. 



fe) Exoept — fef — stook — option — pi 



ens- 



-fef 



dir e ctors, th e plan is administered by a 



<*>- 



oommitt ee , — none of whos e members 
may partioipat e in th e plan. 
Th e numb e r of shar e s allooablo to any 
p e rson under tho plan is reasonable in 



1714 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



relation to th e purpos e of tho plan and 
tho noods of the bank. 

{d) In th e oase of a stock option plan, th e 

number of ohar e s subjoot to th e plan is 
reasonabl e in relation to th e bank's 
oapital otruoturo and anticipat e d growth. 

{e) Shar e o issued to e mployees and offio e ro 

under this R e gulation may be 

authoriz e d but unissued stook whioh has 
boon — authoriz e d — by — stookhold e rs — m 
aeoordano e — with — state — tew; — and — m 
aooordono e with prop e r notifioation of 
shar e hold e rs. 

(f) Stook allocat e d or reserved for a stook 

option plan or a stook purohas e plan 
may not b e includ e d in computing th e 
bank's — inv e stm e nt — limitation, — lean 
limitation, fix e d ass e t limitation, or any 
other limitation bas e d on oapital, until 
tho stock has boon paid for in full. 
(a) Officer and employee plans. A bank may 
establish a stock option or stock purchase plan for 



the benefit of its officers and employees, or any of 
these groups, provided that, in addition to the 



required approval of shareholders, the following 






£31 



conditions are met: 

The plan shall be in writing. 
The plan shall be administered by a 
committee from the board of directors, 
none of whose members, may 
participate in the same. 
In the case of a stock option plan, the 
number of shares subject to the plan is 
reasonable in relation to the bank's 
capital structure and anticipated growth. 
For the purposes of this Subparagraph, 
any plan to which there is allocated no 
more than 10% of the total of the 
bank's outstanding shares and the 
shares reserved for the plan, will be 
deemed reasonable in reaction to the 
bank's capital structure and anticipated 
growth. 

The number of shares which may be 
allocated to any person under a plan is 
reasonable in relation to the purpose of 
the plan and the needs of the bank. For 
the purposes of this Subparagraph, any 
plan which provides that no more than 
40% of the shares which have been set 
aside for option may be allocated to any 
one participant will be deemed 
reasonable in relation to the purpose of 
the plan and needs of the bank. 
(b) Directors stock option plans. A bank may 



14} 



establish a stock option plan for the benefit of its 
directors provided that the following conditions are 
met: 

(1) The plan shall be in writing. 

(2) The number of shares allocated to the 
plan is reasonable in relation to the 
bank's capital structure and anticipated 
growth. For the purposes of this 
Subparagraph, any plan to which there 
is allocated no more than 10% of the 
bank's outstanding shares and the 
shares reserved for the plan will be 
deemed reasonable in relation to the 
bank's capital structure and anticipated 
growth. 

(3) The number of shares allocable to any 
person under the plan is reasonable in 
relation to the purpose of the plan and 
the needs of the bank. For the 
purposes of this Subparagraph, any plan 
which provides that no more than 40% 
of the shares which have been set aside 
for option may be allocated to any one 
participant will be deemed reasonable in 
relation to the purpose of the plan and 
the needs of the bank. 

(c) Shares issued to employees, officers and 
directors under this Rule may be authorized but 



unissued stock which has been authorized by 
stockholders in accordance with state law and in 
accordance with proper notification of 
shareholders. 

(d) Stock allocated or reserved for a stock 
option plan or a stock purchase plan may not be 
included in computing the bank's investment 
limitation, loan limitation, fixed asset limitation, or 
any other limitation based on capital, until the 
stock has been paid for in full. 

(e) Approval. Before a bank may establish any 
plan set forth in Paragraphs (a) and (b) of this 
Rule, it shall submit a written request to the 
Commissioner which includes or incorporates by 
reference the following information: 

(1) A draft of the proposed plan document: 

(2) A copy of the proposed notice of 
shareholders' meeting, proxy, and 
proxy statement: 
The number of authorized but unissued 



13} 



£41 



shares that will be allocated to the plan: 
A copy of any proposed amendments to 
the Articles of Incorporation creating 
authorized but unissued stock and 
eliminating pre-emptive rights as to 
shares reserved under a stock option or 
stock purchase plan: and 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1715 



PROPOSED RULES 



(5) The number of shares of stock 

outstanding at the time the request is 

made and the number of shares which 

have previously been allocated to any 

stock option or stock purchase plan. 

Provided that a proposed plan complies with the 

applicable conditions of Paragraph (a) or (b) of 

this Rule, it will be approved subject to the 

required vote of shareholders and submission of a 

final plan document, final approval will be given 

by the Commissioner of Banks. 

(f) Maximum limitation. Notwithstanding any 
of the provisions of this Section, a bank shall not: 

(1) Allocate in the aggregate more than 
20% of its outstanding shares to stock 
purchase plans; nor, 

(2) Allocate to any one participant more 
than 40% in the aggregate of all the 
shares reserved for option. 

Statutory Authority G.S. 53-10; 53-43; 53-43.3; 
53-92; 53-104. 

SECTION .1700 - NONRESIDENT BANKS 

.1701 DEFINITIONS 

For the purposes of this Section, the following 
definitions shall a pply: 

(11 Loan Production Office. A loan 
production office (hereinafter "LPO") is 
defined as an office in North Carolina of 
a nonresident bank established solely for 
the purposes of soliciting loans. 
Lockbox Service. A lockbox service is 



121 



ID 



an arrangement by which a nonresident 
bank uses a designated post office box 
and a remittance processing center to 
timely receive and collect payments due 
customers of the bank. 
Trust Representative Office. A trust 
representative office (hereinafter "TRO") 
is defined as an office in North Carolina 
of a nonresident trust company or bank 
exercising trust powers established for 
the purpose of soliciting new fiduciary 
accounts for the nonresident trust 
bank 



company or 
information 



to 



and providing 
and facilitating 



communications with its customers in 
North Carolina. 



(4) Business Development Office. 



business development office (hereinafter 
"BDO") is an office in North Carolina of 
a nonresident bank established solely for 
the purpose of representing the principal 



office of a nonresident bank in solicitin 
loan, investments, and other busines 
within this state. 



Statutory Authority G.S. 53-104; 53-115; 53-127. 

.1702 ESTABLISHMENT OF LPO's 

A nonresident bank may establish an LPO i 

North Carolina under written agreement with th 

Commissioner which provides that: 

(1) The LPO may be used to solicit loans 

assemble credit information, maki 

property inspections and appraisals 



121 



121 



141 



complete loan applications, and perforn 
other preliminary paper work 
preparation for the making of loans; 
Loans may not be approved nor or loai 
proceeds disbursed through the LPO: 
The LPO may not be used to solicit o 
accept deposits; 
The LPO may be inspected by_ thj 
Commissioner of Banks for complianci 



151 



with the written agreement, the cost o 
which inspection shall be borne by_ thj 
nonresident bank: 
The nonresident bank will complete am 
keep current a Loan Production Office 



Registration with the Commissioner a 
Banks; and 

(6) If required by the Secretary of State. th< 
LPO will obtain a certificate of authority 



to do business in North Carolina. 



Statutory Authority G.S. 53-104; 53-115; 53-127. 

.1703 ESTABLISHMENT OF LOCKBOX 
SERVICES 

(a) Generally. A nonresident bank ma' 
establish a lockbox service within North Carolina 



through a subsidiary service corporation of the 
bank or parent bank holding company provided the 



following criteria are met: 

(1) The nonresident bank must first notify 



the Commissioner of Banks in writing 



(21 



of their intent to operate such a service 

and 

Such banks must disclose to the 

Commissioner the proposed location of 

the remittance processing center and the 



designated manager of the same. 
(b) Permissible Activity. A lockbox service 



may collect remittances daily from designated p ost 
office boxes and process them for deposit in a 
North Carolina bank for the benefit of the lockbox 



customer. The customer may repossess its funds 



1716 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



leposited in the North Carolina bank at any time 



yhile these funds remain in such accounts, or the 
ustomer may transmit or arrange for the 



ransmission of its funds deposited in the North 



Carolina bank to a location it so designates. 



(c) Annual Report. Nonresident banks operating 
ockbox services in North Carolina must report 
nnuallv in writing to the Commissioner 



ummarizing it operations in North Carolina. An 



dditional services or changes in services must be 



onsistent with North Carolina banking laws and 



emulations. 



•tatutory Authority G.S. 53-104; 53-127. 

1704 ESTABLISHMENT OF TRO's 

(a) A nonresident trust company or bank 
xercising trust powers may establish a TRO in 



forth Carolina under written agreement with the 



Commissioner which provides that: 

(1) The TRO may be used to solicit new 
fiduciary accounts, assemble customer 
information, prepare applications and 
other forms, transfer documents from 
customers to the nonresident trust 
company or bank, provide information 
to customers about their accounts, and 
generally respond to inquiries; 

(2) Fiduciary accounts may not be 
approved nor accepted through the 
TRO: 

(3) The TRO may not be used to solicit or 
accept deposits: 

(4) The TRO may be inspected by the 
Commissioner for compliance with the 
written agreement, the cost of which 
inspection shall be borne by the 
nonresident trust company or bank; 

(5) The nonresident trust company or bank 
will complete and keep current a Trust 
Representative Office Registration with 
the Commissioner of Banks; and 

(6) If required by the Secretary of State, 
the TRO will obtain a Certificate of 
Authority to do business in North 
Carolina. 

(b) Before operating a TRO in North Carolina, 
t nonresident trust company or bank, in addition to 



omplving with Paragraph (a) of this Rule, shall 



omplete a TRO Registration which provides the 



bllowing information: 
(1) The name of 



the nonresident trust 



company or bank; 
(2) The business address of the nonresident 
trust company's or bank's corporate 



office; 

(3) The state in which the nonresident trust 
company or bank is chartered, or if 
federally chartered, the state in which 
the nonresident trust company or bank 
is authorized to engage in a banking 
and trust business; 

14) If the nonresident trust company or 
bank is a subsidiary of a bank holding 
company, the name of such holding 
company and the state in which the 
same is incorporated; 

(5) The business location of the North 
Carolina TRO and the mailing address, 
if different; 

(6) The telephone number of the North 
Carolina TRO; 

(7) The person in charge of the North 
Carolina TRO; 

(8) The number of people who will be 
present soliciting fiduciary accounts in 
North Carolina; and 

(9) If required to be registered as a foreign 
corporation by the Secretary of State, 
the name and address of the North 
Carolina agent for service of process. 

Statutory Authority G.S. 53-104; 53-115; 53-127. 

.1705 ESTABLISHMENT OF BDO'S 

(a) A nonresident bank may establish a BDO in 
North Carolina under written agreement with the 
Commissioner which provides that: 

(1) The BDO may be used to develop 
business relationships within North 
Carolina, solicit loans, credit cards, 
investments, and other business within 
North Carolina; 
{2} The BDO shall be staffed by resident 
representatives; 

(3) The BDO may not approve or have any 
authority to approve loans; 

(4) The BDO may not disburse loan 



£5} 



m 



proceeds or any other money to any 
borrower. Funding for all North 
Carolina loans will be provided by the 
principal office of the nonresident bank 
to the borrower or the borrower's 
account, borrower's agent or to an 
escrow agent; 

The BDO may not solicit or accept 
money for deposit in North Carolina, 
nor issue checks in North Carolina; 
The BDO may not maintain customer 
accounts in North Carolina for deposit 



h21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1717 



PROPOSED RULES 



or withdrawal nor will it advertise or 
will 



m 



represent that it 

services^ 

may 



offer such 



The 



BDO may not collect loan 
Loan payments shall be 



payments, 
made directly to its principal office; 
(8J The BDO may be inspected by the 
Commissioner of Banks for compliance 
with the written agreement, the cost of 
which shall be borne by the 
nonresident bank; 

(9) The nonresident bank shall complete 
and keep current a Business 
Development Office Registration with 
the Commissioner of Banks; and 

(10) If required by the Secretary of State, 
the BDO will obtain a certificate of 
authority to do business in North 
Carolina. 

(b) Before operating a BDO in North Carolina, 
a nonresident bank, in addition to complying with 
Paragraph (a) of this Rule, shall complete a BDO 
Registration which provides the following 
information: 

(1) The name of the nonresident bank; 

(2) The business address of the nonresident 
bank's corporate offices; 

(3) The state in which the nonresident bank 
is chartered, or if federally chartered, 
the state in which the nonresident bank 
is authorized to engage in a banking 
business; 

(4) If the bank is a subsidiary of a bank 
holding company, the name of such 
holding company and the state in which 
the same is incorporated; 

(5) The business location of the North 
Carolina BDO and the mailing address, 
if different; 

(6) The telephone number of the North 
Carolina BDO; 

(7) The person in charge of the North 
Carolina BDO; 

(8) The number of people who will be 
present and developing business rela- 
tionships and soliciting loans and other 
business in North Carolina; and 

(9) If required to be registered as a foreign 
corporation by the Secretary of State, 
the name and address of the North 
Carolina agent for service of process. 

Statutory Authority G.S. 53-104; 53-115; 53-127. 

SECTION .1800 - COURIER SERVICE 



.1801 ESTABLISHMENT OF COURIER 
SERVICES 

(a) Generally. A state bank may provide 
courier or messenger service to its customei 



provided that a written agreement between th 
bank and the customers contains the items j 
Paragraph (b) of this Rule. 

(b) The written agreement referred to in Pan 

graph (a) of this Rule must contain the following 

(1) A statement that the courier is the ager 



of the customer and not the agent of th 
bank. 

(2) A statement that deposits collected b 
the courier or messenger are receive 



01 



by the bank when the deposits hav 
actually been delivered to a teller at th 
bank's premises. 
A statement which indicates that nego 
tiable instruments collected by th 
courier or messenger are paid at th 
bank when delivered to the courier p 
messenger. 



Statutory Authority G.S. 53-43;53-104; 53-115. 



.1802 



(a) 



COMPLIANCE AND DISCLOSURE 
REQUIREMENTS 

A state bank shall disclose to its customer 



that transactions conducted by a courier service an 

in no way insured by the FDIC. 

(b) A state bank must also comply with require 



ments imposed by the Private Protective Servici 
Act, N.C. G.S. 74(c)-! et. seq. 

Statutory Authority G.S. 53-43; 53-104; 53-115. 

TITLE 10 - DEPARTMENT OF 
HUMAN RESOURCES 

ISotice is hereby given in accordance with G.S 
150B-21.2 that the N. C. Medical Care Commissioi 
intends to adopt rules cited as 10 NCAC 3C .3001 
.3101 - .3110, .3201 - .3205, .3301 - .3303, .340. 

- .3405, .3501 - .3503, .3601 - .3609, .3701 
.3708, .3801 - .3804, .3901 - .3907, .4001 -.4005 
.4101 - .4110, .4201 - .4204, .4301 - .4308, .440. 

- .4403, .4501 - .4516, .4601 - .4605, .4701 
.4705, .4801 - .4806, .4901 - .4907, .5001 
.5005, .5101 - .5105, .5201 - .5207, .5301 
.5327, .5401 - .5408, .5501 - .5514, .6001 
.6002, .6101 - .6104, .6201 - .6227; repeal .010 
-.0102, .0104 - .0110, .0201 - .0203, .0301 
.0307, .0401 - .0407, .0501 - .0505, .0601 
.0604, .0701 - .0708, .0801 - .0805, .0807, .090. 



1718 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



0917, .1001 - .1006, .1101 - .1102, .1201 - 
1204, .1301 - .1303, .1401 - .1405, .1501 - 
1508, .1510, .1601 -.1606, .1701 -.1717, .1801 

.1805, .1901 - .1912, .1915 - .1932, .2001 - 
2008, .2020 - .2033 and .2101 - .2105. 

he proposed effective date of this action is May 
1995. 

he public hearing will be conducted at 9:30 
m. on March 10, 1995 at the Council Building, 

01 Barbour Drive, Room 201, Raleigh, NC, 

7603. 

\eason for Proposed Action: To revise and 
wdernize the Hospital Licensure Rules. 

comment Procedures: In order to allow the 
"ommission sufficient time to review and evaluate 
our written comments prior to the hearing, please 
ubmit your comments to Mr. Jackie Sheppard, 
PA Coordinator, DFS, P. O. Box 29530, Raleigh, 
JC 27626-0530, telephone (919) 733-2342 by 
larch 3, 1995, but in no case later than the 
earing on March 10, 1995. 

CHAPTER 3 - FACILITY SERVICES 

SUBCHAPTER 3C - LICENSING 
OF HOSPITALS 

SECTION .0100 - PROCEDURE 

HOI GENERAL CONFERENCE 



No plans to e stablish a hospital ohall b e und e rtak 
n until thos e r e sponsibl e for planning hav e visit e d 



l e Division of Facility S e rvic e s for a gen e ral 
onferonoo in whioh e l e m e nts peculiar to hospital 



onstruotion can be broadly e xplain e d. 



tatutory Authority G.S. 131E-79. 

0102 REVIEW 

All stages of the plans from soh e matio s through 



'orlcing — drawings — shaH — be — r e view e d — by — the 
)ivioion'o staff at e aoh tim e a ohang e is mad e . 



'tatutory Authority G.S. 131E-79. 
0104 APPROVAL 



Approval of plans by th e Division of Faoility 
e rvioos, the Division of Health Sorviooo, and 



Department of Insuranc e shall b e obtained before 
construction or renovation is comm e nc e d. 

Statutory Authority G.S. 131E-79. 

.0105 APPLICATION 

(a) Prior to admission of patients, an application 
for a lioonso ohall be submitt e d to the Division of 
Faoility S e rvio e o. 

(b) — Forms may b e obtain e d by contacting th e 
Division of Faoility Services. 

(o) The application shall s e t forth tho ownership, 
staffing pattorno, m e dioal servic e s to b e r e nd e r e d, 
prof e ssional staff in charge of primary services, 
th e maximum b e d oapaoity and gen e ral information 
that would b e h e lpful to tho Division in knowing 
fully of th e hospital's op e rating program. 

Statutory Authority G.S. 131E-77. 

.0106 CERTIFICATE 

When th e hospital building has m e t con s truction 
r e quir e ments, a b e d oapaoity has boon establish e d 
and approv e d in aooordano e with Section .1500 of 
this Subchapter, and application for licens e has 
boon approv e d, th e n a c e rtificate of lic e nsur e shall 
b e issued in aooordano e with classification dosigna 
tions as sot forth in Rul e .0202 of this Subchapter. 

Statutory Authority G.S. 131E-77. 

.0107 LENGTH OF LICENSE 

A lioonso, unl e ss sp e cified for a l e ss e r period, is 
e ff e ctiv e for th e y e ar ending Decemb e r 3 1 . 

Statutory Authority G.S. 131E-77. 

.0108 RENEWAL 

(a) — Eaoh lic e nse must b e r e n e wed at the begin 
ning of the cal e ndar y e ar. 

(b) — Renewal is accomplish e d by the compl e tion 
by th e hospital of a r e applioation form which is 
s e nt to tho hospital in th e lat e fall. 

Statutory Authority G.S. 131E-77. 

.0109 LICENSURE SURVEYS 

(a) — Prior to th e initial issuance of a lic e nse to 
op e rat e a hospital, th e Division will conduct a 
surv e y to d e t e rmin e compliance with r e gulations 
promulgat e d pursuant to G.S. 13 IE 79. 

{b) — Wh e n consid e r e d n e c e ssary, th e Division 
may oonduot an inv e stigation of a op e oifio com 
plaint in any lic e nsed hospital. 

(e) — Hospitals that ar e aoor e ditod by th e Joint 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1719 



PROPOSED RULES 



Commission — ee — Accr e ditation — ef- — H e althoar e 
Organizations (JCAHO) shall ohooso one of th e 
following options: 

(4-) Aoor e dit e d — hospitals — may — agfee — te 

provid e th e Division with: 
<A) — JCAHO Accreditation Certificat e , 
<-B) — JCAHO Statement of Construction, 

<€) — JCAHO R e ports a-B-d 

Recommendations, 
{&) — JCAHO Int e rim S e lf Survey R e ports, 

(E) — p c rmi ss i efi — te — participat e — m — aay 
r e gular — surv e y — conducted — ey — the 
JCAH. 



I# 



of th e information li s t e d 



(o) (1) (D) 



a review 
Subparagraphs (o) (1) (A) 
indicates deficiencies with or e xceptions 
to lic e nsur e regulations contain e d in 
this Subchapt e r, th e n th e Division may 
conduct surv e ys or partial surveys with 
special e mphasis on d e ficiencies noted. 
If a revi e w indicat e s complianc e with 
licensure regulations contain e d in this 
Subchapt e r, — the — Division — wiH — set 
conduct a lic e nsur e survey e xo e pt as 
provid e d in (b), (C) (1) (E), and (d) of 
this Rul e . 

{—) Aoor e dit e d ho s pitals which do not agr ee 

te — provid e th e Division with JCAH 
r e ports found in (c) (1) of this Rule 
may b e surv e y e d annually but will b e 
surveyed by the Division at l e ast onc e 
e v e ry two years. 
(4} — The Division reserv e s the right to conduct 

any validation survey in hospitals that choos e th e 

option under (o) (1) of this Rule. 
(e-)- — The Division may surv e y non aooredit e d 

hospitals annually but will surv e y th e s e hospitals at 

l e ast e v e ry two years. 

Statutory Authority G.S. 131E-79. 

.0110 ITEMIZED CHARGES 

(a) — Th e faoility shall e ith e r pres e nt an it e miz e d 
li s t of charge s to all discharg e d pati e nts or th e 
facility shall includ e on patients' bills whioh ar e 
not itemized notification of th e right to r e qu e st an 
it e miz e d bill within 30 days of r e c e ipt of the 
non itemiz e d bill. 

{e} — If request e d, th e facility shall present an 
itemized list of charges to each pati e nt, or his 
re s pon s ible party. 

(e) — The it e miz e d listing shall includ e , at a 
minimum, those charges incurr e d in th e following 
s e rvic e ar e as: 



{4-) Room rates; 

(3) Laboratory; 

(J) Radiology and Nuol e ar Modioino; 

(4) Surg e ry; 

(=>) An e sth e siology; 

{&) Pharmacy -; 

£7) Emorgonoy and ambulatory oerviooo; 

{&) Specializ e d Car e ; 

(9) Extended Care; 

fW} Prosthetio and Orthop e dio applianoo s- 



£44-) Other professional s e rvices. 

{&) — Th e faoility shall indioate on the initial t 



r e n e wal lic e nse application that patient bills or 



it e mized, or that e aoh pati e nt or responsible part 
is formally advised of the patient' s right to requc < 



an it e miz e d listing within 30 days of r e ceipt of 



non itemized bill. 

Statutory Authority G.S. 131E-91. 

SECTION .0200 - GENERAL 

.0201 CLASSIFICATION OF MEDICAL 
FACILITIES 



(a) — Th e classification of "hospital" shall b 
restricted to faciliti e s that provid e as their primar 



functions diagnostic s e nde e s and intensive mediee 



and nursing car e in th e treatment of aout e stages o 
illness. — On th e basis of sp e cialized facilities an 



s e rvic e s — available, — eaefe — suoh — hospital — will b 
lio e ns e d as to th e following m e dical typ e s; 

(4-) g e n e ral acut e oar e hospital; 

(3) r e habilitation hospital; 

{3} d e signat e d primary car e hospital; 



f4) f e derally certifi e d — primary — eft* 

hospital. 



(e) AH — oth e r — inpati e nt — m e dical — faoilitie 



acc e pting — pati e nts — requiring — skill e d — nuns in 
s e rvic e s but whioh ar e not op e rated oo a part o 



any hospital within th e abov e m e aning shall b 
consid e r e d to b e op e rating as a nursing homo an( 



th e r e for e ar e not subj e ct to hospital lic e nsur e . 

(e) — Each ho s pital applying for licensure will b 
classifi e d in aooordano e with the determination o 



th e Division of Faoility Servic e s. 
Statutory Authority G.S. 131E-76; 131E-79. 
.0202 TYPES OF LICENSES 



Each hospital lioens e issu e d shall indicate thorooi 



wheth e r it is a class I, olass II, or temporal - ; 
conditional hospital license in accordance with th < 



following provisions: 



{44 Hospital lio e nses, olass I, will bo issue * 

to n e w or e xisting hospitals that oomph 



1720 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2j 



PROPOSED RULES 



m- 



with — roquiromontfl — of tho oonotruotion 
s tandards established in th e Stat e Building 
Code and tho ruloo and r e gulationa of th e 
Division of Facility S e rvio e s; 
Hospital lio e no e o, olass II, will b e issu e d 



to existing hospitals that do not oomply 

with the oonstruotion standards 

established in the Stat e Building Code but 
hav e oomploted m e asur e s recomm e nd e d 
by tho Stat e Insurance Departm e nt to 
provide oooupants with a minimum of 
saf e ty — whioh — can — be — afford e d — by 
oomplianoo with such r e commendations 
and otherwis e moot tho r e quir e m e nts of 
th e Division of Faoility S e rvices; 



showing th e siz e and shape of tho ontiro 
site and th e location of all e xisting and 
propos e d faciliti e s; 

{§) Plans shall b e submitt e d in triplicat e in 

order that th e Division may distribute a 
copy to th e Stat e Insuranc e Department 
for r e vi e w und e r Stat e Building Cod e 
r e quir e ments and to th e Division of 
H e alth Sorvio e s for r e vi e w under state 
sanitation r e quir e m e nts. 
(o) Looation 



(3) Temporary conditional hospital lic e ns e 

will bo issu e d to hospitals that do not 

fully m ee t — requirements ef- — the 

oonstruotion standards e stablish e d in th e 
Stat e — Building — Cod e — and — have — net 
compl e t e d m e asur e s recomm e nd e d by th e 
Stat e Insuranc e Department to provid e a 
minimum of safety, or do not m ee t oth e r 
r e quir e m e nts of tho Division of Faoility 
Sorvio e s, — but whioh agree to — oorr e ot 
specifi e d — d e fici e nci es — within tho time 
period pr e scrib e d by th e Division. 

atutory Authority G.S. 131E-79. 



203 CONSTRUCTION 



(a) Standards. Tho design and oonstruotion shall 
i in accordanc e with th e oonstruotion standard of 



o North Carolina Division of Faoility S e rvio e s, 
e North — Carolina Building Cod e , — and — looal 



unioipal ood e s. 

(b) Plans. — Submission of plans: 



ft) B e for e construction is b e gun, plans and 

sp e cifications oov e ring oonstruotion of 
the — new — buildings, — alteration s — ef 
additions to e xisting buildings, or any 
chang e in faoiliti e s must b e submitt e d to 
th e Division for approval; 

{3) Th e r e upon, th e Division will r e vi e w th e 

plans and notify th e lio e nse e that said 
buildings, — alt e rations, — additions, — ef 
ohangeo ar e approv e d or disapprov e d 
with — such — r e comm e ndations — as — the 
Division will oar e to mako; 

(3) In order to avoid unn e c e ssary e xpense 

in ohanging final plans, it is suggested 
that as a preliminary st e p, propos e d 
plans in skotoh form b e r e vi e w e d with 
th e Division; 

(4) Th e plans shall inoludo a plot plan 



{+) The — site — fef — new — construction — ef 

e xpansion must have tho approval of 
tho Division; 

(3) Hospitals should b e so looatod that thoy 

afe — free — from — undu e — nois e — from 
railroads, — fr e ight yards, — main traffic 

art e ri e s, schools aad — childr e n's 

playgrounds; 

Th e — site should not b e e xpos e d to 



(4)- 



smok e , foul odors, or dust from n e arby 

industrial plants; 

Th e ar e a of th e sit e should b e suffici e nt 



te — permit — futur e — e xpan s ion — and — te 
provid e ad e quat e parking faoilities; 

(5) Th e s it e should b e e asily acc e ssibl e to 

pati e nts, doctors, and employees; 

(e) Availabl e paved roads, adequat e wat e r, 

s e wag e , — and — pow e r linos should b e 
tak e n into consid e ration in s e lecting th e 



Statutory Authority G.S. 131E-79. 

SECTION .0300 - ADMINISTRATION 

.0301 GOVERNING BOARD 

(a) Tho governing board, or owner, or th e 

p e rson or p e rsons designat e d by the owner a s the 
governing authority shall b e r e sponsibl e for s ee ing 
that th e obj e ctiv e s sp e cifi e d in th e chart e r (or 
resolution if publioly owned) ar e attain e d. 

{b} — Th e gov e rning board s hall bo the supr e m e 
authority — m — the — hospital — te — whioh — the 
administrator, th e m e dical staff, th e p e rsonn e l, and 
all auxiliary organizations ar e dir e ctly or indir e ctly 
r e sponsibl e . 

(o) Th e gov e rning board shall b e r e sponsibl e for 
th e formulation or approval of such bylaws as may 
be — desirable — fef — the — prop e r — op e ration — of th e 
hospital . 

{d) — Th e board shall oonduot r e gular m ee tings 
and — may — appoint — offio e rs — and — committ ee s — in 
carrying out its functions. 

(e) The — board — shall — s e l e ct — and — appoint — a 



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February 1, 1995 



1721 



PROPOSED RULES 



comp e tent — administrator — and — d e l e gat e — te — &i» 
ex e cutive authority and responsibility. 

(f) The board shall appoint a oompot e nt m e dical 
staff — compos e d — ef — an — adequat e — numb e r — ef 
physioiano whom it d ee ms qualified aft e r a formal 
r e vi e w of th e ir r e sp e ctive credential s . 

(g) — The gov e rning board s hall onoourag e th e 
admini s trator and the m e dical staff to qualify th e 
hospital — 4e — m ee t — the standards — of th e — Joint 
Commission on Accr e ditation of Hospitals. 

{&) A hospital with one or mor e units, or 

portions of units, however d e scrib e d, utilized for 
psychiatric — of — substanc e — abus e tr e atm e nt — s hall 
adopt — policies — implem e nting — th e provisions — ef 
North Carolina Gen e ral Statut e s Chapter 122C 
Article 3 and Article 5 parts 2, 3, 4 , 5, 7, and 8 . 

Statutory Authority G.S. 131E-79. 

.0302 ADMINISTRATOR 

(a) There shall b e a oompet e nt e x e cutive offic e r 
or administrator with authority and r e sponsibility 
fef — the — operation — ef — the — hospital — ie — aH — rts 
administrativ e and prof e ssional functions, subj e ct 
only to th e policies enaoted by th e gov e rning board 
and to s uch ord e rs as it may issu e . 

(e) T-ke — administrator — shaH — be — t&e — direct 

r e pr e sentative of th e governing authority in th e 
manag e m e nt — ef- — the — hospital — and — shaH — be 
re s pon s ible to said board alone for th e prop e r 
p e rformanc e of his duti e s. 

{e) The administrator shall provide liaison 

between the gov e rning body, th e medical staff, th e 
nursing — staff, — and — oth e r — d e partm e nts — ef- — t&e 
hospital. 

(d) The administrator shall advis e th e gov e rning 
board in th e formulation of hospital polici e s. 

{e) — It is r e comm e nd e d that th e administrator 
pr e par e — a — manual — ef- — hospital — polici e s — and 
proc e dures for us e by e mploy ee s and m e dical staff 
to assist in understanding th e ir responsibilities 
within th e organization of th e hospital. 



Statutory Authority G.S. 131E-79. 

.0303 ACCOUNTING 

(a) — Within busin e ss hours, th e finanoial and 
statistical r e oords of th e hospital shall b e availabl e 
for insp e ction at all times by th e Division of 
Facility — S e rvic e s — through — its — daly — authorized 
r e pres e ntatives. 

(b) Accounting proc e dur e s should b e carri e d out 
in accordanc e with a r e cogniz e d s y s tem of ho s pital 
accounting — and s hould be — ad e quat e to — p e rmit 
satisfactory auditing. 



{&) It — is — recomm e nded — that — aa — audit - 



p e rform e d at l e ast annually by a qualifi e d audit 



who is not a r e gular e mploy ee of the hoopital. - 
Statutory Authority G.S. 131E-79. 
.0304 TELEPHONES 



Th e r e should b e at least on e t e l e phone on chk 
floor — with — provisions — fef — calling — outside t ) 



hospital building(s) and additional t e lephone s- 



ext e nsions — as — required — fef — proper — inters 



communications and for summoning h e lp prompt 
in case of fire or other emergency. 

Statutory Authority G.S. 131E-79. 



.0305 ADMISSION AND DISCHARGE 



(a) Th e hospital administration shall provide tt 
admitting — offio e — with — writt e n — admission — m 



discharg e polici e s whioh r e fl e ct th e e otablisho 



purpos e s of th e hospital and th e intent of i 



governing board. 
{e) — Th e re shall be on th e pr e mises at all time 



an e mployee authoriz e d to rec e ive patients and t 
mak e administrativ e d e cisions on th e ir dispositioi 



(e) — A pati e nt shall b e admitt e d only und e r th 
oar e of a physioian mooting th e provisions of Rul 



.0 4 4 of this Subchapter. 
(4) — Reasonabl e pr e cautions shall b e tak e n t 



e nsur e th e saf e ty and legal rights of all pati e nts. 
(e) — A compl e t e and p e rman e nt record shall h 



maintain e d — fef — aH — outpati e nts — aad — inpati e nt 
including th e dat e and tim e of admission ani 



discharg e . — A reasonabl e effort shall b e made ti 



verify 1 the full and tru e nam e , address, date o 
birth, — near e st — ef- — k4&; — provisional — diagnosis 



condition on admission and discharge, roferrinj 
physicians, att e nding physioian or s e rvic e . 



{f) — All pati e nts shall b e provided at the tim e o 
their admission with an id e ntification brac e l e t 



band, 



-ef — other — s uitabl e — d e vic e — far — positiv i 
id e ntification. 



{g} He — m e ntally — competent — adult — shall b < 

detain e d in th e institution against his will, nor shal 



a ohild b e d e tain e d against th e will of a parent oi 
legal guardian. — This restriction shall not apply t< 



p e rsuasion of th e pati e nt in his own interest tc 
consid e r the possible oons e quenoes of his actions 



nor to th e t e mporary d e t e ntion of a mentall) 
disturb e d pati e nt for th e prot e ction of himself anc 



oth e rs, p e nding prompt legal disposition as may b e 



provided for in G.S. — 122C whioh is hereby 
adopted by reference pursuant to G.S. 150B 11 (o) 



Docum e ntation of th e commitm e nt process shall be 



r e tain e d — fef — aH — involuntary — commitments — a 



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NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



tooordanoo with th e provisions of Rulo 10 NCAC 
\ C .1 1 05. 



(h) An infiint or ohild ohall bo dioohargod only 
e tho custody of its par e nt, legal guardian, or 



Miotodian. — Exo e ption to thio oan be mad e to a 



ncmbor of th e immediate family or fri e nd having 
ho parents' validated cons e nt aooording to hospital 

Statutory Authority G.S. 131E-79. 

0306 RECORDS AND REPORTS 

{a) Th* — following — e ss e ntial — docum e nts — and 

oforono e s shall bo on fil e in th e administrativ e 



)ffioos of th e hospital: 



Q) o e rtifioat e — ef- — incorporation (i# 

incorporat e d); 

{2) bylaws of the gov e rning authority (if 

applicabl e ); 

{3} bylaws of tho modioal staff; 

{4) minut e s of th e governing authority (if 

applicabl e ); 

(§) minutes of th e m e dioal staff and staff 

committ ee s; 

(6) applications of all curr e nt m e mb e rs of 

the — m e dioal — staff, — prof e ssional — and 

t e ohnioal personnel containing 

qualifications a-&d supporting 

informati ee — docum e nting — oonformit y 
with — requisit e — prof e ssional — lic e nsing 
laws, action by staff oommitt ees , and 
th e gov e rning authority; 

{7) insumno e polici e s, — mortgages, — deeds 

and oth e r contract s (or tru e copi es ) to 
which th e hospital is a party; 

{8) rul es — and — r e comm e ndation s — ef- — the 

Division of Faoility S e rvic e s r e gulating 
th e op e ration of hospitals; 

(9) r e port of tho most r e oont in s p e ction by 

th e Joint Commission on Accr e ditation 
of Hospitals (if applicabl e ); 

(iO) n e c e ssary lioonsos, p e rmits, and 

c e rtificat e s for th e hospital, and for 
c e rtain staff p e rsonn e l, as r e quir e d. 
(b) Eaoh hospital shall submit r e ports containing 



uoh pertin e nt data a s r e quir e d by th e Division of 
facility S e rvio e s. 



{e) — Institutions licensed und e r th e s e standards 
oust fully comply with th e rul e s and regulations 



i romulgat e d by th e North Carolina Division of 



i e alth Services relating to vital statistics. 
Statutory Authority G.S. 131E-79. 
0307 RISK MANAGEMENT 



Pursuant to — &■& — 13 IE 96 the r e quir e d risk 
manag e ment program r e quirement will b e m e t: 

ft) Eaoh hospital shall assign to a specific 

staff — m e mb e r r e sponsibility fer 

development and administration of th e 
program. 

(3) Eaoh hospital shall hav e a writt e n policy 

statem e nt — e vid e ncing — a — ourr e nt 
commitm e nt — te — the — risk — manag e m e nt 
program. — In addition, th e hospital shall 
d e v e lop writt e n proc e dur e s and policies 
applicabl e to a risk management program 
whioh are revi e w e d annually and ur 



ipdat e d 



m- 



as n e c e ssary. 

Eaoh — hospital — shall — maintain — lin e s — ef 

oommunioation b e tw ee n tb« risk 

management program and oth e r functions 
relating to quality of patient care, saf e ty, 
and professional s taff p e rformanc e . 

{4) R e levant e ducational programs fef 

hospital — employees, — prof e ssional — staff, 
and — the — gov e rning — body — shaH — be 
pr e s e nt e d at l e ast annually ^ 

(S) A writt e n r e port of th e activities of the 

risk — manag e m e nt — program — shall — be 
provid e d — at — least — annually — te — the 
gov e rning body. 

Statutory Authority C.S. 131E-96. 

SECTION .0400 - MEDICAL STAFF 

.0401 APPOINTMENT 

(a) M e dioal staff appointm e nts shall b e mad e by 
the gov e rning body upon r e comm e ndation of th e 
m e dioal staff. 

{b) — Appointm e nts shall b e mad e annually, at 
least whil e th e y ar e on a provisional status. 

{«) — Eaoh appointm e nt s hall s p e cify clearly and 
e xplicitly th e natur e of th e olinioal privil e ges 
granted, tog e th e r with any specified conditions 
sp e oifi e d conditions of th e appointm e nt. 

(d) An applicant shall b e assign e d to e ith e r the 
honorary m e dioal staff; consulting medioal staff; 
active — medioal — staff; — assooiato — m e dioal — staff; 
oourt e sy — m e dioal — staff; — ef — te — similar — staff 
classifications. 

Statutory Authority C.S. 131E-79. 

.0402 QUALD7ICATIONS 

(a) — Ev e ry p e rson admitt e d to practic e in th e 
hospital — shaH — qualify for — m e mb e rship on th e 
m e dioal staff by submitting a signed application in 
writing whioh shall oontain th e following data: 



>:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1723 



PROPOSED RULES 



age; — yeaf — and — school — ef — graduation, — date — ef 
licensur e , — stat e m e nt of postgmduato or special 
training and e xp e ri e nc e , statement of the type of 
m e dicine the applicant desires to practice, a pledge 
that if appoint e d the applioant will comply with th e 
rules and r e gulations of th e hospital so far as th e y 
aff e ct him and his memb e rship on th e m e dical 
staff, and include a stat e ment of his own sp e cial 
qualifications and a resolution against Division of 
fees in accordance with th e r e quirem e nts of th e 
Am e rican Coll e ge of Surg e ons. 

(¥) As — individual — file — fef — eeeh — physioian 

practicing in the hospital shall be maintain e d. 
Such file shall contain the information outlin e d 
abov e in (a) of this Rule as well as all actions 
tak e n by the m e dical staff and the gov e rning board 
concerning the type of privil e ges grant e d and other 
applicabl e data. 

Statutory Authority G.S. 131E-79. 

.0403 ORGANIZATION 

(a) In any — hospital — us e d — by — twe — ef — mor e 

physicians, th e physicians and surgeons privileged 
to practice in the hospital shall b e organiz e d as a 
d e finit e m e dical staff which shall initiate and, with 
the approval of th e gov e rning body of th e hospital, 
adopt — bylaws, — aed — policies — whioh — specifically 
provid e : 

fl-) for eligibility for m e mbership on th e 

ste§t 

(3) fef — the — numb e r — and — fr e qu e ncy — ef 

medical staff meetings and att e ndanc e 
r e quir e m e nts. Monthly m ee tings of th e 



activ e — staff — are — r e comm e nded. 



4f 



monthly meetings are not held, then: 
(A) — monthly d e partm e ntal conf e r e nc e s in 
thos e — hospitals — wh e r e — the — clinical 
services are well organized and e ach 
d e partm e nt is large e nough to m ee t as 
a unit; or 



m- 



tMy- 



mon 
record 



meetings 
end — tissue 



-ef- — the — m e dical 



committee s — te 



ad e quately — apprais e — tee — quality — ef 
medical work ar e r e quired. 
In th e case of th e latter, appropriat e action shall be 
tak e n — net — less — than — monthly by — the — e x e cutiv e 
committ e e of th e staff and r e ports mad e to th e 
activ e staff; 

@) that on th e basis of the patient' s records 

th e m e dical staff r e vi e w and analyz e at 

regular int e rvals th e ir clinical 

experienc e in the various departments 
of th e hospital. 
fb) Ail — rul e s — and — r e gulations — and policies 



adopted by th e m e dioal — staff and a rootor - 



m e dioal staff memb e rs shall bo available to tl 



Division upon request. 
(e) — Th e organiz e d m e dioal staff shall annua l 



e l e ct a staff m e mb e r to b e ohi e f of staff, and - 



d e partm e ntalization is appropriat e , th e re shall 1 



appoint e d or elected a qualifi e d member of tl 



medical staff to b e r e sponsibl e h e ad or chief 



each of th e departments or services in the hospito 
such as obstetrics, p e diatrics, surg e ry, medioin 

(d) Such committ e es of th e m e dioal staff shall 1 



appoint e d — as — afe — required — fef — the — necosoai 



transaction of business. 

Statutory Authority G.S. 131E-79. 

.0404 SUPERVISION OF PATIENT CARE 



All p e rsons admitted to any institution oovoro 
by this Subchapter must b e und e r th e oaro of 



physioian who is in r e ceipt of hospital privilege 



granted pursuant to G.S. 13 IE 85 and: 
ft) in good standing, and legally lic e nsed t 



m- 



practioe in North Carolina; 
comp e tent in his field. 



Statutory Authority G.S. 131E-79. 

.0405 ORDERS FOR MEDICATION 
AND TREATMENT 



(a) He — medication — ef — treatment — shall b 

administ e r e d e xc e pt in r e sponse to th e order of 



physioian, exo e pt as the m e dioal staff may provid 

in its rul e s and r e gulations. 

(b) — Suoh orders shall be dated and r e cords 



directly in th e patient ohart or in a computer o 
data processing syst e m which provid e s a hard oop; 



printout of th e order for the patient ohart. 



m e thod — must — be establish e d by eaoh — hospita 
gov e rning body to id e ntify all p e rsons who r e oon 



suoh ord e rs and to safeguard against fraudulen' 

r e cording s . 

(e) — All orders for m e dication or treatment shal 



b e auth e nticat e d at th e tim e of r e cordation by th i 
ord e ring physician; provid e d, that verbal order 



shall be authentioat e d within 2 4 hours after th e) 
ar e giv e n by the ordering physician or by 



physioian involv e d with th e car e of tho pati e nt 



Authentication must b e accomplished by signatur e 



initials, — computer — e ntry — ef — code, — ef — ethei 
m e thod(s) not inconsistent with tho laws, rules and 



r e gulations of any oth e r applicabl e jurisdictions. 

(d) The names of drugs must b e recorded in ful 
and not abbreviat e d. 

(e) Th e m e dioal staff shall have tho authority to 



1724 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



tpprovo medications uo e d in tho hospital and ohall 
w tablioh ruloo, not inoonsistont with th e provisions 



>f thin Rulo, gov e rning ord e rs for habit formi ng-ef 



iangorous drugs. 



Statutory Authority G.S. 131E-79. 

0406 AVAILABILITY FOR EMERGENCIES 

One or mor e duly lic e ns e d physicians ohall b e 
tvailabl e or on call for e mergencies at all tim e s. 



Statutory Authority G.S. 131E-79. 

0407 MEDICAL LIBRARY 

Tho hospital must maintain a m e dical r e f e r e nc e 



ibrary or baoio t e xtbooks suffici e nt to m ee t th e 
loodo and r e quir e m e nts of th e s e rvio e s of th e 



lospital. 



Statutory Authority G.S. 131E-79. 

SECTION .0500 - NURSING SERVICE 

0501 ORGANIZATION 

{a) — Th e d e partment of nursing and all nursing 
)orsonn e l ohall bo organiz e d to provid e oompl e t e 



tnd effici e nt car e to e ach patient, and th e authority 



md responsibility of each nuro e and all nursing 
)orsonn e l — shall — bo clearly — d e fin e d by — sp e oifio 



written polioi e s. 



(b) — Th e r e shall bo monthly m e etings of th e 
irofeosional nursing staff to r e vi e w and analyz e 



he nursing s e rvic e and to d e t e rmin e th e quality 



ind increas e th e e ffici e ncy of th e nur s ing car e 
e nd e r e d. 



{e) Applications — fer- — e mploym e nt — shell — be 



lubmittod in writing to tho p e rson r e oponoible for 
mr s ing p e rsonn e l, — and — each — application — shell 
i ontain accurat e information as to th e e ducation, 



raining, e xp e ri e nc e and p e rsonal background of 



t aoh applicant. — Prior to e mploym e nt th e hospital 
i hall asc e rtain th e aoouraoy of th e e mploym e nt 



ipplioQtion with resp e ct to e ducation, training, and 
i xp e ri e noo of tho applicant. 



{e) — All professional nur s ing p e rsonn e l shall b e 
egiotorod in tho Stat e of North Carolina. 



Statutory Authority G.S. 131E-79. 

0502 PROFESSIONAL PERSONNEL 

(a) Nurse on Duty 

{V) Th e re shall b e at l e ast on e r e gistered 

nuro e on duty at all tim e s- 
Exc e ption to thi s r e quir e m e nt may b e 
considered — f-e-f — physician's 



m- 



clinic hospital with limit e d b e ds wh e n 
the — physioian — is — m — the — faoility. 
However, in th e absence of a physioian 
a register e d nurs e must b e on duty at 
all times. 

0) There — shell — either — be — at — least — one 

rogioter e d — nuroe — ee — duty — fer — eaeh 

nursing unit; oth e rwise, th e r e shall b e 

adequate oup e rvision by on e or mor e 

circulating r e gist e r e d nurses. 

(b) Comp e tence. The superintend e nt or dir e ctor 

of nursing se rvice shall be a comp e tent p e rson 

with administrative and e xecutive training and 

e xp e ri e nc e and a r e gist e r e d nurse, in th e Stat e of 

North Carolina. 

(o) Amount of Car e . Nursing car e shall b e that 
amount of profeooional and non professional oar e 
e ssential — to — provid e — prop e r — treatm e nt — tor- — the 
w e ll b e ing and th e r e oov e ry of th e pati e nt. 

{d) — Sup e rvision. — All persons not e mploy e d by 
th e hospital — wfee — r e nd e r sp e cial — duty nursing 
s e rvic e — m — the — ho s pital — shell — be — und e r — the 
sup e rvision — of th e — nur s ing — sup e rvi s or — of th e 
d e partm e nt or s e rvic e conc e rn e d. — Th e y s hall b e 
curr e ntly licens e d in th e Stat e of North Carolina. 

{e) Education. A — program — of in s e rvic e 

e duoation — shall b e maintain e d for all — nursing 
s e rvic e p e rsonn e l. 

Statutory Authority G.S. 131E-79. 

.0503 NON-PROFESSIONAL PERSONNEL 

{a) Praotioal — nurse s , — sub s idiary — work e rs, 

ord e rli es and att e ndants a ss ign e d to th e nursing 
s e rvic e shall b e giv e n only those duti e o for whioh 

they — are trained. They — shell — be — under th e 

sup e rvision of a graduat e nurs e staff. 

(b) All praotioal nur ses shall b e r e gist e r e d in th e 
Stat e of North Carolina. 

Statutory Authority G.S. 131E-79. 

.0504 FACILITIES 

(a) Nurs e s' Station Faciliti e s 

(4-) A — look e d, — w e ll illuminat e d — m e dicin e 

cabin e t; n e arby faciliti e s for sink with 
hot and — ee4d — running — wat e r and a 

count e r — fer — the pr e paration ef 

m e dioation s shall b e provid e d. 

{2} Where narcotics ar e k e pt at th e nurs e s' 

station, a s e parat e , look e d, p e rman e ntly 
s e cur e d oabin e t or oth e r faciliti e s for 
narootios shall b e provid e d. 

(3) Th e r e ohall b e ad e quate space for filing 

and r e oording pati e nts' charts. 



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February 1, 1995 



1725 



PROPOSED RULES 



(4) Utility — rooms — shaH — be — conv e ni e ntly 

locat e d, — asd — shall — provid e — ad e quat e 
spac e — and — faciliti e s — fef — the — prop e r 
oloansing, sterilizing (except wh e re a 
c e ntral supply s e rvice is maintain e d), 
and storage of nursing supplies and 
equipment. — Clean and dirty activiti e s 
shall be segr e gat e d. 

{§) Separat e provisions shall bo made for 

the e mptying, cleaning and sterilizing 
of bedpans. 
Nursing Unit Faciliti e s 



(±) Steril e suppli es and e quipm e nt for th e 

administration of blood — transfusions, 
aed — intravenous — aed — subcutaneous 
s olutions shall be readily availabl e . 

(3) Item s — s«eh — as — intrav e nous — stands, 

bedside rails, wh ee lchairs and str e tch e rs 
shall be stored so as to permit -free 
passag e of p e rsonnel and e quipment and 
to avoid blocking em e rg e ncy e xits. 
fe) — Cl e aning of Materials and Equipm e nt 

fl-) All suppli es and e quipm e nt us e d in 

pati e nt car e shall be properly cl e aned or 
st e riliz e d — b e tween — use — fef — differ e nt 
pati e nts. 

(-3) Methods — for cl e aning, — handling — asd 

storing all suppli e s and e quipm e nt shall 
b e such as to prevent th e transmission 
of infection through th e ir us e . 

(3) Aft e r discharg e of a pati e nt from th e 

hospital, th e b e d, mattr e ss cov e r, b e d 
linen s , b e dside furniture and e quipm e nt 
shall b e prop e rly clean e d and p e rsonal 
ut e nsils shall b e st e riliz e d b e for e r e us e 
by oth e r pati e nts. 



Statutory Authority G.S. 131E-79. 

.0505 PROCEDURES 

(ft) — Hot wat e r bags shall b e cov e r e d b e for e us e . 
Car e must b e e x e rcis e d in th e ir us e to sec that 
wat e r do e s not e xc e ed a saf e t e mperatur e . — Wh e n 
e l e ctric — h e ating pads — afe — us e d, — they — shall — be 
maintained in safe working order. 

(b) R e straints oth e r than sid e mils for b e ds shall 
be us e d only on the written order of a physician 
and may b e appli e d only wh e n th e y ar e necessary 
to prev e nt injury to pati e nts or to oth e rs. 

(e) Physician — ord e rs — fef — m e dication — aed 

treatment shall b e issu e d, e x e cut e d, r e corded and 
auth e nticat e d in conformity with Rule .0 4 05 of this 
Subchapt e r. — Sp e cial proc e dur e s shall b e d e tailed 
in writing and fil e d at th e appropriat e nursing 
station. 



Statutory Authority G.S. 131E-79. 

SECTION .0600 - PERSONNEL 

.0601 PERSONNEL 

(ft) — All positions shall b e authorized by t & 



gov e rning authority, — eith e r dir e ctly — or throug 



del e gation — by — the — gov e rning — authority — to tk 



admini s trator. 



(te) — Each prosp e ctive employee must submit ai 
application — ef- — employm e nt — which — provides 



description of p e rsonal background, identification 
training, e xp e ri e nc e and r e f e r e nces. 

Statutory Authority G.S. 131E-79. 

.0602 PERSONNEL POLICIES 

Explicit and uniform policies shall b e establishoc 



for e ach job classification, conc e rning pay day 
siek l e av e , vacations, holidays, overtime 



ho s pitalization, retirement plan, l e aves of absence 



aed — oth e r — b e n e fits — ef — r e lated — conditions — & 



e mploym e nt. A stat e m e nt of all such policies shal 



b e furnished all p e rsonn e l upon comm e ncing work 



Statutory Authority G.S. 131E-79. 



.0603 HEALTH EXAMINATIONS 



(a) — All p e rsonnel shall und e rgo pre e mploymoni 
screening. — Pre e mployment scre e ning proc e dur e s 



will b e d e t e rmin e d by th e hospital's governing 



body and m e dical staff. — Such proc e dure s shall b e 
r e cord e d in writing. 



(b) — Follow up scre e ning for all employees shaL 
b e d e t e rmin e d by th e hospital's gov e rning body 



and medical staff. Th e proc e dures to b e used shall 
b e r e cord e d in writing. — R e cords of all soroonins 



activities — shall b e availabl e for r e view by the 
D e partm e nt. 



Statuton Authority- G.S. 131E-79. 



.0604 RECORDS 

An individual fil e shall b e maintain e d for e ach 



employee. — Such fil e shall contain th e application 
for e mploym e nt, physical examination results and 



oth e r data which has a b e aring on or is of valu e to 



th e facility whil e th e p e rson is an active employ ee 

Statutory Authority G. S. 131E-79. 

SECTION .0700 - LABORATORY 
SERVICES 

.0701 FACnTTTES 



1726 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



The hoopital ohall provid e laboratory oorvioeo as 
required to perform th e n e ooooary laboratory t e ats 
and oxaminationp for diagnoois and treatment of 
tho olaooifioation of pati e nto admitted. — Equipm e nt, 
when indicat e d, ohall b e oalibratod in aooordnno e 
with manufacturer's r e eommondationo. 

Statutory Authority G.S. 131E-79. 

.0702 ORGANIZATION 

T-he — laboratory — shell — be — und e r — the — dir e ot 
s uporvioion of a olinioal pathologiot or a phyoioian 
who hao had op e oial training in olinioal laboratory 
diagnooio and whoso judgm e nt is aoo e pt e d in 
doubtful findingo. 

Statutory Authority G.S. 131E-79. 

.0703 RECORDS 

(a) All r e qu e oto for laboratory s e rvic e ohall b e in 
writing. 

{b) — A laboratory report on e ach procedur e or 
autopoy, indicating th e findings and individual who 
performed th e test or examination, ohall b e fil e d in 
tho patient's m e dical record. 

Statutory Authority G.S. 131E-79. 

.0704 AUTOPSY FACILITIES 

{a) — An autopoy room shall b e provid e d. If this 
room is not on the hoopital pr e mis e s, a writt e n 
agr ee m e nt ohall be in e ff e ot under which ouoh a 
room or rooms locat e d in a mortuary e stablishm e nt 
or e otabliohm e nto, or oth e r appropriate moility, ar e 
made availabl e to th e hoopital pathologiot for th e 
p e rformanc e of po s tmort e m e xaminations. 

{b) Surfao e o — of wallo, — flooro, — fixtur e s — aed 

e quipm e nt — shall — be — smooth — aad — of washabl e 
material. 

{e) — The autopsy room shall hav e appropriat e 
e quipment, including at l e ast on e sink suitabl e for 
h e avy cl e aning and one oinlc for handwashing, 
e aoh with hot and cold running wat err 

44) — The autopsy room shall hav e r e frig e ration 
faciliti e s for at least on e cadav e r. 



Statutory Authority G.S. 131E-79. 

.0705 TISSUE REMOVAL 

(a) — All opeoim e ns r e mov e d at surg e ry will b e 
submitted for pathological — e xamination, — exc e pt 
opeoimens whioh by th e ir natur e do not permit 
m e aningful examination, ouoh as oataraots, for e ign 
bodioo (including oynthotio materialo, orthopedic 
applianooo and bullets), residual portions of tissue 



used as graft, normal tissu e r e moved for exposur e 
(ouoh ao a rib during thoracotomy or old ooar 
tioouo at laparotomy), n e wborn infant for e skin, 
normal — placentas, — tooth, — to e nailo, — fing e rnailo, 
gallotonoo, traumatioally amputated or ourgioally 
amputat e d — gangrenous — extromitioo — of — portions 
th e r e of, — and — d e brid e d — tioou e — from — traumatic 
wound s . — Both th e m e dioal otaff and th e gov e rning 
board muot formally approv e a d e partur e from the 
pr e viouoly accepted practic e of s e nding all tissu e 
for examination. — Th e rul e s and r e gulations of th e 
m e dioal staff must fully oover a polioy on tissu e 
e xamination. 

{b) — Any sp e cim e n e ligibl e for exemption is also 
e ligibl e — fef — pathological — examination — at — the 

discr e tion of th e operating surgeon. Removed 

op e oim e no that are not oubmitt e d for pathological 
examination will be d e oorib e d or docum e nt e d in 
th e op e rativ e r e oord. 

{«) — Th e e xtent of th e pathological e xamination 
ohall b e d e termin e d by th e pathologist. 

Statutory Authority G.S. 131E-79. 

.0706 TESTS 

(a) Laboratory t e sts to b e p e rform e d on a patient 
at — th« — time — of admission — (if any) — shall — be 
e stablish e d by th e m e dioal staff and bo approv e d 
by th e gov e rning board of th e hospital. — In th e 
ev e nt th e m e dioal staff and gov e rning board e l e ct 
not to e stablish routin e laboratory t e sts for n e w 
admissions, th e r e qu e st for s uoh t e sts shall be left 
to th e discr e tion of the admitting phyoioian. 

{b) — S e rological tests for pati e nts admitt e d shall 

b e optional with th e hospital. However, there 

shall b e ad e quat e r e cords indicating that obst e trical 
pati e nto hav e had a s e rological t e st during their 
ourr e nt pr e gnanoy. 

(o) Wh e n laboratories outsid e of th e hospital ar e 
us e d, suoh laboratories muot bo approv e d by th e 
gov e rning board and m e dioal staff of th e using 
hospital. — In cas e of suoh usag e , a l e gibl e copy of 
th e laboratory r e port must b e mad e a part of th e 
p e rtin e nt pati e nt r e oord. 



Statutory Authority G.S. 131E-79. 

.0707 BLOOD BANK 

{a) — Hospitals whioh provid e for procur e m e nt, 
storag e — and — transfusion — ef- — blood — shell — have 
acceptable faciliti e s for suoh and shall m ee t th e 
standards of th e Am e rican Assooiation of Blood 
Banlco ao outlin e d in tho most ourr e nt e dition of 
Standards for a Blood Transfusion Sorvioo. 

{b) — Th e gov e rning authority ohall designat e th e 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1727 



PROPOSED RULES 



pathologist e-F oth e r physioian a-s 

physioian in oharg e of th e blood bank s e rvio e . 

fa) — R e oords shall b e kept on fil e indicating the 
r e c e ipt — and — disposition — of all — blood — handled. 
Particular car e shall b e tak e n to ascertain that 
blood administ e r e d has not e xce e d e d its e xpiration 
dat e , and m ee ts all crit e ria for saf e administration. 

fa) — The ho s pital shall make arrang e m e nts to 
se cur e on s hort notic e all nooossary suppli e s of 
whole blood, typ e d and cross matoh e d as r e quir e d, 
for emergenci e s. 

Statutory Authority G.S. 131E-79. 



.0708 ELECTROCARDIOGRAPHY 

fa-) Arrang e m e nt s f-e-F n e o e ssary 



electrocardiographic proc e dur e s shall b e provid e d. 
If s uch e quipment is available on th e pr e mis e s 
ther e shall b e provi s ion for periodic calibration. 

ft?) If this e quipm e nt is provid e d at th e ho s pital, 
a — qualifi e d — physioian — sbeH — be — appoint e d — te 
supervis e th e e l e ctrocardiographic t e chnicians. 

(e) — Th e gov e rning board shall appoint on e or 
mor e physioians approv e d by th e m e dical staff to 
int e rpr e t e l e ctrocardiograms mad e in th e hospital. 

(d) The int e rpr e t e r's sign e d r e port shall b e mad e 
a part of th e patient' s ohart. 

Statutory Authority G.S. 131E-79. 



SECTION .0800 - RADIOLOGICAL 
SERVICES 

.0801 FACILITD2S 

fa) — Ho s pitals shall hav e ad e quate spac e and 
equipm e nt for diagnostic x ray and fluoroscopic 
e xaminations, including faciliti e s for d e velopment 
and s torag e of radiographic film. 

{b) — Th e faciliti e s must b e so designed and th e 
e quipm e nt install e d as to provid e th e protection 
sp e cified — by — National — Bureau — e$ — Standards 
Handbook 76, M e dioal X Ray Prot e ction Up To 
Thr ee Million Volts. 



Statutory Authority G.S. 131E-79. 

.0802 ORGANIZATION 

fa) — The x my d e partm e nt shall b e und e r th e 
sup e rvision of a full tim e radiologist or consulting 
radiologist, — ef — a — physioian — e xp e rienced — m 
radiology. 

(b) — Aotivitioo of th e x ray s ervic e may e xt e nd to 

radio th e rapy, i-a — w h i o h oos e — t-h-e 

physioian in oharg e shall b e appropriately qualified. 

fa) — It is the responsibility of th e hospital to 



e nsur e that all x ray e quipment is operated un<k 



prof e ssional sup e rvision by oompetent poroorum 



trained — m — the — use — ef— 



x ray — equipment cm 
knowl e dg e abl e of saf e ty precautions r e oommond e * 



by th e National Bur e au of Standard sr 
Statutory Authority G.S. 131E-79. 



.0803 RECORDS 



fa) — A writt e n r e port on each x ray film takoi 
shall b e mad e a part of the pati e nt's modioa 



r e cord. 
{b) — Radiology r e ports shall be sign e d by tin 



physioian responsible for th e proc e dur e . 
(e) — R e oords of personnel e xposures to ioniz 



m 



radiation must b e maintain e d as stat e d in Rut 



.080 4 of this S e ction. 
(4) Copies of all — reports made by privah 



phy s ici s ts — surv e ying — the — radiographic — faoilitia 



must b e provid e d th e Division. 



Statutory Authority G.S. 131E-79. 



.0804 PERSONNEL MONITORING 

(a) Procedures for p e rsonn e l monitoring Ghall be 



maintain e d for e aoh individual working in th e aroi 



of radiation wher e th e r e is a r e asonabl e probability 
ef- — r e c e iving — on e fourth — ef- — the — maximun 



p e rmissibl e dos e , 
(b) Personn e l monitoring r e oords resulting fron 



th e use of film badges or dosim e t e rs must bx 



maintain e d. R e adings must b e on at l e ast t 

monthly basis. 
(e) Upon t e rmination of e mploym e nt, e aoh 



work e r s hall b e provided with a summary of hi 
e xposur e r e oord. 



fd) Permanent records — of exposure — on al 

monitor e d — personnel — must — be — maintained — fei 



r e vi e w by th e Division. 
Statutory Authority G.S. 131E-79. 

.0805 RADIOACTIVE ISOTOPES 

fa) AH — radioactiv e — isotop e s, — wheth e r — fei 



diagnostio, th e rap e utic, or r e s e arch purposes ohall 



be — r e c e iv e d, — handl e d, — and — dispos e d — ef- — m 



acoordono e with th e r e quir e m e nts of tho North 

Carolina Division of Radiation Protection Sorvio e c. 

(b) If radioactiv e isotop e s ar e used, tho hospital 



governing body shall appoint a radiation saf e ty 
committ ee , 
(e) — This oommitt ee shall r e oommond polioi es 



aed — proc e dur e s — m — aooord — wrth — recognized 



standards for th e us e of radioisotop e material s; 
inoluding sp e cial conditions as may bo noooooary 



1728 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



or personnel and e quipm e nt, and for reviewing 
my use of ° U0D materialg for oonformano e-with 
KJoptod polioi e s reoomm e ndod to th e gov e rning 

Statutory Authority G.S. 131E-79. 

0807 ADDITIONS OR RENOVATIONS 
TO THE RADIOGRAPHIC SUITE 

Approval — of initial — and — chang e d — plans — and 



s pecification s — fer- — structural — and — e quipm e nt 
nstallationo must b e obtained from th e Division 



3oforo work is oomm e no e d. — Sp e cifications must 



jo furnished by a qualifi e d physicist approvabl e to 



ho Division. — The Division will provid e , upon 



oquoot, a list of suoh individuals. 



Statutory Authority G.S. 131E-79. 

SECTION .0900 - GENERAL 
CLINICAL SERVICES 

0901 SURGERY FACILITIES 

{a) — Ev e ry hospital in which surgical op e ration s 



iro perform e d — shaH — have — an — op e rating — suit e 
noluding an ad e quat e ly d es ign e d op e rating room, 



jropor sorubbing, sterilizing and dr e ssing room 
[aoilitios, saf e storag e for an es th e tio ag e nts and 



ooognizing advanc e s in surgical t e chniqu es and 
jroo e dur e s. 



{b) — This suit e shall b e provid e d e xclusiv e ly for 
mrgioal proc e dur e s and shall b e locat e d as not to 



3 e us e d as a passag e b e tw ee n other parts of th e 



i uffioi e nt e quipment and instrum e nts in k ee ping 
with — the — r e quir e m e nts — ef- — modern — surg e ry 



lospital and shall not bo subj e ot to oontamination 



from oth e r parte of th e hospital. 
Statutory Authority G.S. 131E-79. 

.0902 SURGERY ORGANIZATION 

(a) Th e surgical staff shall consist of physicians 
with delin e at e d surgioal privil e g e s as sp e cified in 



the oorporat e or m e dical bylaw s . 
(b) The governing body shall a ss ur e that surgioal 



privileges ar e grant e d only to lic e ns e d physioians 
who hav e r e l e vant olinioal training and e xp e rienc e . 



(o) A rootor of surg e ons with the d e lineation of 
fcheif — privil e ges — shaH — be — maintained — by — the 



operating room supervi s or, 
(d) The surgioal se rvic e s shall mak e provisions 



for surg e ons with privileges to bo availabl e at all 



tim es — fef — e m e rg e ncy surg e ry, and fef 



post operative olinioal manag e m e nt. 
(e) — Th e operating room shall b e und e r th e 



sup e rvi s ion of a regist e red nurs e with r e l e vant 
training and experi e nc e . 

(f) — Suffici e nt prof e ssional and non prof ess ional 
p e rsonne l — s hall — be — availabl e — te — provid e — the 
n e oessary supporting s e rvic e s and to maintain an 
as e ptio environme nt 

Statutory Authority G.S. 131E-79. 

.0903 SURGERY PROCEDURES 

(a) B e for e a pati e nt r e quiring general or regional 
an es th e sia — undergoes — surgery, — the — following 
saf e guards must b e fulfill e d and r e cord e d in th e 
ohart: 

f4-) A modioal history, if obtainable, shall 

b e tak e n to asc e rtain th e condition for 
whioh surgery is r e commended and to 
e valuate — the — patient's — ability — te 

withstand — surg e ry. T-bk — shaH — be 

suppl e m e nt e d by an additional history 
tak e n — by — e ith e r — the — surg e on — er 
an e sth e tist conc e rning drug s e nsitiviti e s, 
r e o e nt food intak e and oth e r p e rtin e nt 
foots. 

(3) A — phy s ical — e xamination — shaH — be 

p e rform e d in sufficient dotail to identify 
significant abnormalities and to evaluate 
the patient's — oardiao and respiratory 
ability to withstand surg e ry. 

{3} Each — pati e nt — should — have — those 

laboratory — proc e dur e s — d e t e rmin e d 
n e o e ssary by th e rul e s and r e gulations 
of th e m e dical staff or pr e scrib e d in 
appropriat e standing ord e rs. 

(4) Consultations — as — required — by — the 

m e dical staff rul es and r e gulation s shall 
b e obtain e d. 

{#) A — provisional — diagno s is — shaH — be 

e stablish e d. 

{6) Con se nt of th e pati e nt or l e gal guardian 

fef — surg e ry — shaH — be — obtain e d — in 

aooordano e — with — the — policy — ef- — the 

institution. 

{b) — B e for e a patient undergoes surgery, — the 

following — additional — saf e guards — shaH — atee — be 

fulfilled: 



&- 



v e rification of th e 



pati e nt's id e ntity in 
aooordano e with the polioies of the 
institution, 

{2) v e rification of a surgeon's authority to 

und e rtak e the propos e d op e ration. 
(e) — Any of th e abov e pr e operativ e proc e dur e s 
may bo waiv e d, if in th e judgment of th e att e nding 
surg e on, th e risk of d e lay e ndang e rs the patient's 

11 iu. 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1729 



PROPOSED RULES 



{d) — An acc e ptable aoeptio techniqu e shall b e 
observed by members of th e surgical team in all 
op e rativ e procedures. — Proper car e shall be taken 
to pr e v e nt contamination — of th e surgioal — field, 
sterile tables or op e rating team by any oaus e . 

{©) — After on op e ration on a septio oas e , th e 
op e rating room shall be thoroughly cl e ans e d in a 
manner adequate for th e typo of contamination 
e xisting. 

{£) — An accurat e and compl e t e description of the 
technique of op e ration and th e findings and a 
stat e ment of organs or tissues removed tog e ther 
with th e post op e rativ e diagnosis shall be ent e r e d 
by th e surgeon in th e patient's r e cord as soon as 
practicable following the operation. 

(g) All hospitals providing surgical services shall 
have — availabl e — facilities — for- — the — pathological 
examination of tissue sp e cim e ns. — This may b e 
provid e d either on th e premis e s or by arrangem e nt 
through — affiliation, — &r — other — m e ans, — with — a 
pathological laboratory. 

{b) A — chronologioal — r e gist e r — ef — surgioal 

operations shall be maintain e d in th e surgical suite. 

Statutory Authority G.S. 131E-79. 

.0904 PROTECTION AGAINST 

ANESTHETIC EXPLOSIONS 

Rul e 10 NCAC 3C .120 4 s hall control. 

Statutory Authority G.S. 131E-79. 

.0905 OBSTETRICS FACILITIES 

(a) Mat e rnity 

{ty Obst e trical facilities — shall b e located 

and arranged so as to provid e for e v e ry 
reasonabl e prot e ction of mothers from 
infection and from cross infection. 

t2j Standards of the Am e rican Coll e g e of 

Obstetricians — aed — Gynecologists — as 
outlin e d in the most current e dition of 

Manual e-f- Standards i-a 

Obstetric Gynecologic Practice shall b e 
used as a guide. 
fb) — S e rvices and Car e 

f4-) There must b e satisfactory capability 

for the care of pati e nts in labor. — This 
s hall include id e ntification of high risk 
moth e rs and f e tus e s, continuous 



d- 



ectronio f e tal monitoring, caesar e an 
d e liv e ry capability within 30 minutes, 
blood — aed — fresh — frozen — plasma — fef 
transfusion, anesthesia on a 2 4 hoa r 
basis, — radiology — aed — ultra — sound 
examination, — neonatal — r e suscitation, 



consultation and tranofor agre e ment. 
{3) Rooms us e d for pati e nts in labor oha 



afford — privaoy, — aad — be — convenien t 



locat e d with r e f e renoo to the doliva 



room. — If labor rooms also oorvo ■< 



"birthing — room s ", — they — sball — \ 



equipped — te — handl e — obstetric — as 



&- 



n e onatal e m e rg e nci e s. 

If analgesia io used, — beds shall t 



equipp e d with sid e rails. 
{4) Th e r e must b e faciliti e s for examinatie 



and preparation of pati e nts ao require 
by th e attending physioian. 
(c) D e livery Room 
(4-) Rooms in which patients are usual] 



deliv e r e d shall be used for no oth( 



purpos e than for th e completion 
labor and d e livery. — Each room shall b 



provid e d with the necessary fhoilitic 
and e quipm e nt as d e termin e d by th 



medical staff, principally the obstetric* 



servic e . If circumcisions ar e p e rformo 
in the delivery rooms, they shall b 



confin e d to hospital newborns. 



{3} A written sch e dule of proc e dures fo 

cl e aning and s e tting up the deliver 



room following each delivery' shall b 
placed in or near the room. 



{3^ Th e d e livery room shall b e staffed an 

e quipp e d te handle obstetri 



emergencies and to provid e n e onah 



r e suscitation. 






Incubator [se e Rule .090 8 (a)(5) of thi 



Subchapt e r] 



Faciliti e s — fef — compliance — with — &-£ 
130A 173, r e garding treatment of th 



eyes of newborn shall be maintained. 



(9- 

69- 



-Afi — acc e ptable — means — of idontifyin 
each infant shall be available in e ver 



d e liv e ry room. 



Protection against anesthetic explosion 
(se e Rule .1204 of this Subchapter). 



Statutory Authority G. S. 131E-79. 

.0906 OBSTETRICS ORGANIZATION 

(a) An on call schedule or other procedure shal 



b e establish e d to e nsure that a physician witl 



obstetrical privil e ges is availabl e within 30 minute 
at all tim e s to p e rform d e liv e ri e s at the hospital. 



(b) — Ev e ry birth occurring in a hospital shall t x 
att e nded by a m e dioal dootor who shall possess th 



qualifications prescrib e d in Rul e .0 4 02 of thi 
Subchapt e r. — Nothing in this Paragraph is intond et 
to prev e nt members of th e hospital resident staff ' 



1730 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2j 



PROPOSED RULES 



when acting und e r th e authority and supervision of 
fee attending dootor, from att e nding at births. 

{e) — The physioian shall b e notified when th e 
patient is admitt e d and immediately upon ons e t of 

IflJang 

(4) — A regist e red nurs e , with r e l e vant training 
and experienc e in obstetric and n e wborn oaro, 
s hall bo responsibl e at all times for th e nursing 
e aro of maternity pati e nts and newborn infants. 



(o) A qualified m e mb e r of the h e alth oar e t e am 
s hall be assign e d responsibility for obs e rving th e 



patient, monitoring h e r progr es s in labor and 
recording all pertin e nt information. 



Statutory Authority G. S. 131E-79. 

.0907 OBSTETRICS PROCEDURES 

(a) — Routin e nursing procedures for car e of 
obstetric patients shall b e pr e par e d in written form. 



(b) Aoourato and oomplete m e dioal r e oords must 



bo provided for all — mat e rnity patients, — and a 
separate r e oord maintain e d for infants. 



(o) Any indication of infection must b e r e port e d 



imm e diately to th e att e nding physioian in charg e of 
the pati e nt and to th e hospital admini s tration. 



{d) — Immediate s e gr e gation and i s olation of all 



mothers with infection, fev e r or oth e r condition 
inimical to th e saf e ty and w e lfar e of oth e rs must 
bo provided in a separat e room. 



(o) A moth e r shall b e considered infootod if: 
(4) Sh e has a oommunioabl e disease or is 

s usp e ot e d of such, or if sh e is a oarrier; 

(3) Sh e nurs e s an infeot e d infant; 

0) Sh e is d e liv e r e d outsid e th e mat e rnity 

unit of th e hospital in which sh e is 

aft e rward s oar e d for; 

Sh e has an un e xplain e d f e v e r during th e 



W- 



pu e rpenum. 
{£) Fef — the — prot e ction — ef- — moth e rs, — e v e ry 



in s titution — r e o e iving — mat e rnity — pati e nts — shall 



obs e rve th e following rul es and r e gulations: 

{±9 Th e numb e r of visitors to a maternity 

pati e nt shall not e xc ee d two, e xclusive 
of th e husband, at any tim e ; 

(3) Visitors (inoluding ohildr e n) known to 

hav e an e xisting &r r e c e nt 

oommunioable — infection, — as — weH — as 
thos e — having — oontaot — with — sues 



m- 



infection, shall be e xclud e d; 
Visitors must not sit on b e ds. 



Statutory Authority G.S. 131E-79. 

.0908 NEWBORN FACILITIES 

(a) Nursery 



«- 



A nurs e ry, not to b e us e d for any other 
purpos e , — must — be — provided — for- — the 
newborn with ad e quat e spao e , light and 
v e ntilation. 

(3) The — nurs e ry — shell — be — looat e d — and 

arrang e d as to provide for oompl e t e 
prot e ction — of n e wborn — infants — from 
infection and from oross infection from 
pati e nts — m — oth e r — s e rvio e s — m — the 
hospital. 

0) Th e r e shall b e provisions for a susp e ot 

nurs e ry — fet — infanta — susp e ot e d — ef- — a 

contagious, inf e ctious, e-f 

oommunioabl e diseas e ; and ther e shall 
b e provisions for th e oompl e t e isolation 
of infants — with — a — known — infectious, 
contagious or oommunioabl e di se as e - 
N e wborn — and old e r — infants admitt e d 
from th e outside shall not b e oar e d for 
in th e n e wborn nursery. 

(4) The n e wborn nur se ry shall b e staff e d 

and — e quipp e d — te — provide — n e onatal 
r e suscitation. 



&- 



Faciliti e s — without 



jiliti e s — witnout — an — int e nsiv e — eafe 
nursery shall e stablish proc e dures and 
methods to transport sick neonates to a 
r e gional n e onatal unit. 

{6} The pr e matur e should bo oar e d for in a 

s e parat e nurs e ry ef — should — be 

segr e gat e d in th e n e wborn nurs e ry. 

f?) A larg e plainly l e gibl e weH 

thermom e t e r shall b e provid e d for the 
nursery. 

(8) An — accurate — scal e — fef — w e ighing 

n e wborn shall b e provid e d. 

{9) Running — bet — and — eeld — wat e r — and 

suitabl e r e c e ptacl e s for the disposal of 
wast e — aad — soil e d — lin e ns — shaH — be 
provid e d in or adjao e nt to e aoh nurs e ry- 
Formula Room 



<k> 



{4} Th e r e shall b e ad e quat e facilities for the 

storag e , — handling and pr e paration of 
formulas for infants apart from food 
provid e d to adult pati e nts. 

(3) A room must be designat e d for th e 

e xclusiv e pr e paration of formula unl e ss 
th« — hospital — r e li es — entir e ly — en — a 
pr e packaged sterile disposabl e formula 
system. 

0) Dirty bottl es and acc e ssori e s should be 



stor e d 



from — the — oount e r ar e a 



W- 



away 

wh e r e formulas ar e prepared, sterilized 
and cooled. 
Wh e n — formula 4s — pr e par e d — en — site; 



sterilization and refrigeration e quipm e nt 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1731 



PROPOSED RULES 



must b e provided in th e formula room. 
When a dioposable formula system in 
u s ed, adequat e storag e spao e ohall be 
provided and an as e ptio environm e nt 
maintain e d — m — handling — pr e packag e d 
formulft r 

Statutory Authority G.S. 131E-79. 

.0909 NEWBORN ORGANIZATION 

(a) A r e gist e red nur se shall b e r e oponsibl e at all 
tim e s for the nursing oar e of n e wborn infants. 

{b) — Nursery p e rsonn e l shall observ e univ e rsal 
infection control pr e oautions. 

Statutory Authority G.S. 131E-79. 

.0910 NEWBORN PROCEDURES 

(a) A — syst e m — ef- — positiv e — and — s e cur e 

cross id e ntification of moth e r and n e wborn infant 
shall b e adopt e d by th e hospital. 

(b) The m e dical staff shall provid e for a physical 
e xamination of each n e wborn infant as soon as 
practicabl e aft e r birth, and p e riodic r e e xamination 
prior to discharge from the hospital, with finding s 
in eaoh instanc e r e cord e d. 

^Fhe- 



continuous 



nurs e ry — shall b e suppli e d with — a 

s upply ef- — oxyg e n. Routin e 

odministration of oxyg e n to newborn infante is 
prohibited and conc e ntration of oxyg e n shall b e 
r e strict e d to l e v e ls b e low 4 p e roent, exc e pt wh e re 
th e physician incorporat e s in his writt e n ord e r the 
reason for pr e scribing a gr e at e r concentration, and 
s p e cifi e s the concentration d e sir e d. 

(d) Visitors may not e nter th e nurs e ry. 

{e) — A view window where babi e s ar e shown to 
visitors must b e on e fourth inch wir e d plate glass 
with no s ection larg e r than 1,296 square inches. 

(f) No visitors e xc e pt th e fath e r shall b e allow e d 
in th e mother' s room during nursing hours. 

(g) — In cases wh e r e th e n e wborn infant r e mains 
in the moth e r's room (rooming in), th e r e shall b e 
handwashing facilities and nur s ing sup e rvision of 
moth e r and infant. 

fh) Standards — ef — r e comm e ndations — of th e 

Am e rican Acad e my of P e diatrics for hospital car e 
of n e wborn infante shall b e used as a guid e . 



Statutory Authority G.S. 131E-79. 

.0911 PEDIATRICS 

(a) Facilities 

ft) A hospital providing pediatrio core shall 

hav e prop e r faciliti e s for th e oaring of 
childr e n apart from th e se rvic e s for 



adult — pati e nts — aed — apart — from tt 

n e wborn nursing s e rvic e . 

(3) Th e r e shall b e proper facilities an 



proc e dur e s for th e isolation of ohildfe 



with infeotious, contagiou s — e 



oommunioablo conditions. 
(b) Organization. Nursing p e rsonnel ohall bo e 



assigned and looat e d, r e lative to the p e diatrio are 



or aooommodations, as to maintain sup e rvision - 



childr e n at all tim es . 
{e) — Proc e dur e s. — Standards or r e oommondatioi 



ef- — th* — Am e rican — Aoademy — ef- — P e diatric s — ft 



hospital oar e of n e wborn infants ohall b e used as - 



guide. 

Statutory Authority G. S. 131E-79. 

.0912 DENTISTRY 

(a) — A Hospital offering dental o e rvioeo oha 



comply with the r e quir e m e nts of this S e otion. 

■fb) Faciliti e s. The — spac e — and — e quipmoi 

allooat e d — te — tbe — d e ntal — s e rvic e s — shall — be- 



aooordano e with g e n e rally aoo e pt e d standards o 



praotio e . 
(o) Organization 



w- 



All d e ntists on th e d e ntal s e rvice of lb 



institution shall b e : 
(A) — Graduates — of sohools — approv e d o 



t e ntativ e ly approv e d by th e Counoi 
on D e ntal Education; 



fB) — Lic e ns e d to praotio e d e ntistry in th( 
Stat e — ef- — North — Carolina — and — bs 



e ligibl e — fef — memb e rship — ifl — t& 
Am e rican — D e ntal — Association — » 



National D e ntal Association and looa 



and stat e d e ntal sooi e tieo; 



{G) — \Yhon special work in oral surg e ry 



p e riodontics, orthodontics and oth e 



sp e cialti e s — ef- — d e ntistry — is — te — bs 
undertaken, — the — dentist — shftH — hi 



grant e d privileges in those areas. 



(3) Institutions providing — dental servic es 



may — provid e — fef — dental — interns — aw 
r e sid e nts — appoint e d — according to tbj 



usual — r e gulations — fef — the — hospital - 
D e ntal int e rnship s and r e sidencies shall 



m- 



oonform to r e quir e m e nts for approva 
of dental int e rnships and residencies. 
D e ntal — s e rvic e s — sbaH — be — under th e 



dir e ction of a d e ntist, preferably on e 
e ngag e d — m — the — g e n e ral — praotio e — el 



d e ntistry, and shall funotion as other 

se rvic e s do. 

{4) Writt e n polioieo and proc e dures shall b e 



provid e d for dental oervioeo. 



1732 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



{§) Baoio and ourr e nt rofor e noo material 

shall bo availabl e . 

{£) i\ll requests for diagnostic or tr e atm e nt 

Borviooo shall b e sign e d by e ith e r th e 
attending d e ntist or physioian. 

{7) Records shall bo a part of the hospital 

modioal records syst e m. A uniform 

method — shall — be — establish e d — fef 
recording data. 



(d) Procedures. Pationto admitt e d by a dentist to 
10 hospital for d e ntal oar e shall bo giv e n the sam e 



iodioal appraisal, — by a physician — or surg e on 



aving a licens e to practic e in North Carolina, as 



ioso admitt e d to oth e r s e rvio e s. 



tatutory Authority G.S. 131E-79. 

9913 PSYCHIATRIC OR SUBSTANCE 

ABUSE SVCS: APPLICABILITY OF 
RULES 

The rul e s oontainod in 10 NCAC 3C .0913 



)917 shall apply only to inpati e nt services unl e ss 
thorwis e specifi e d. 



tatutory Authority G.S. 131E-79. 

)914 DEFINITIONS APPLICABLE TO 
PSYCHIATRIC OR SUBSTANCE 
ABUSE SVCS 



(a) — "Certified couns e lor" m e ans an alcoholism, 
rug abuse or substanc e abus e couns e lor who is 



B rtifi e d by th e North Carolina Substanc e Abus e 
rof e ssional C e rtification Board. 



'C e rtifi e d substano e abus e 



ouns e lor/ s up e rvisor" means an individual who is 
'o e rtifi e d couns e lor" as d e fin e d in 10 NCAC 3C 



)91 4 (a) and is designated by th e North Carolina 
iubstano e Abus e Professional C e rtification Board 



b a qualifi e d substano e abus e sup e rvisor. 



{&) — "Clinical/prof e ssional sup e rvision" m e ans 



? gularly — sch e dul e d — assistanc e — by — a — qualifi e d 
l e ntal health prof e ssional or a qualifi e d substano e 



bus e prof e ssional to — a staff m e mb e r who — is 



roviding — dir e ct, — thorapeutio — intervention to — a 
lieat — e? — cli e nts. The — purpos e — ef- — clinical 



.ip e rvision is to e nsur e that e aoh cli e nt r e c e iv e s 
ppropriato tr e atm e nt — or habilitation which — is 



onoiotont with acc e pt e d standards of practic e and 
l e needs of th e cli e nt. 



{d) — "D e toxifioation s e rvic e " means a s e rvice 



rovidod in a unit or d e partm e nt whos e primary 
urposo — is — te — treat — substano e — abus e — through 



e toxifioation. 

( e ) "Diroot oaro staff' m e ans an individual who 

rovidos — activ e — dir e ot — ease; — tr e atm e nt, — ef 



r e habilitation or habilitation s e rvices to clients on 
a continuous and regularly sch e dul e d basis. 

(f) "Poyohiatrio nurs e " m e ans an individual who 
is lioens e d to praotio e as a r e gistered nurso in the 
Stat e of North Carolina by th e North Carolina 
Board of Nursing and who is a graduate of an 
aoor e ditod master's level program in psychiatric 
m e ntal health nursing with two years of e xperienc e 
or has a master's degr ee in behavioral sci e nc e with 
two years of sup e rvis e d clinical — experience in 
psyohiatrio mental h e alth nursing or has four y e ars 
of sup e rvis e d olinioal e xp e ri e nc e in psyohiatrio 
mental health nursing. 

{g) "Psyohiatrio — service" — means — a — service 

provid e d in a unit or d e partm e nt whos e primary 
purpos e is to tr e at m e ntal illn e ss. 

(h) "Psyohiatrio — sooial — worker" — means — an 

individual who holds a ma s t e r's d e gr ee in sooial 
work from an accr e dit e d s ohool of sooial work and 
has two y e ars of olinioal s ooial work e xp e ri e nc e . 

(i) — "Psyohiatrist" m e ans an individual who is 
lio e ns e d to praotio e m e dioin e in North Carolina 
and who has compl e ted an aooreditod training 
program in psychiatry. 

<j) — "Psychologist" m e ans an individual lioens e d 
to praotio e psyohology in North Carolina by th e 
North — Carolina — Stat e — Board of Examin e rs — ef 
Pmotioing Psychologists. 

(k) "Qualifi e d m e ntal h e alth prof e ssional" means 
any on e of th e following: — psyohiatrist, psyohiatrio 
nurse, praotioing psyohologist, psyohiatrio sooial 
work e r, an individual with at least a master's 
d e gr ee in a r e lated human servic e field and two 
y e ars of sup e rvis e d olinioal e xp e rience in mental 
h e alth — s ervic e s — ef — an — individual — with — a 
baooalaureat e degr ee in a r e lat e d human s e rvic e 
field — and — fe«f — years — ef- — supervis e d — clinical 
e xp e ri e nc e in m e ntal h e alth s e rvio e s. 

{f) "Qualifi e d — substano e abus e prof e ssional" 

m e ans an individual who i s : 
fl-) o e rtifi e d — by — the- 



North — Carolina 



Substano e — Abus e Prof e ssional 

Certification Board; or 

(3) o e rtifi e d by th e National Consortium of 

Chomioal D e pendency Nurs e s, Ino.; or 

{£) a graduat e of a coll e g e or university 

with — a — baooalaur e at e — ef — advanc e d 
d e gre e in a human s e rvio e r e lat e d fi e ld 
with docum e ntation of at — least — twe 
y e ars of sup e rvis e d exp e ri e nc e in th e 
profession of alcoholism and drug abus e 
couns e ling. 
(») — "R es traint" m e ans th e limitation of one's 
fr ee dom of mov e m e nt and includes th e following: 

(4-) m e chanical — r e straint — which — m e ans 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1733 



PROPOSED RULES 



restraint of a oli e nt with th e int e nt of 
oontrolling b e havior with moohanioal 
d e vic e s — which — inolud e , — but — are — net 
limited to, cuffs, anldo otmpo, sh ee ts or 
restraining ohirto. 

(2) phyoioal r e straint whioh means r e straint 

of a oli e nt until oalm. — As uo e d in th e s e 
Rules, the term physical restraint does 
not apply to th e us e of profe ss ionally 
r e cogniz e d — m e thods — fef — th e rap e utio 
holds of brief duration (fiv e minut e s or 
less), 
(ft) "Rostriotiv o facility" m e ans a faoility so 

d es ignated by the Divi s ion of Facility S e rvic e s 

whioh uses m e ohanioal r e straint or s e clusion in 

accordance with G.S. 122C 60 in ord e r to r e strain 

a cli e nt's freedom of mov e m e nt. 
(e) — "S e clusion" means isolating a oli e nt in a 

separat e — look e d — room — fef — the — purpos e — ef 

oontrolling a cli e nt's b e havior. 
(p) — "Substance abus e servic e " m e ans s e rvio e 

provid e d in a unit or d e partm e nt whoso primary 

purpos e is to tr e at substanoe abus e . 



Statutory Authority G.S. 131E-79. 

.0915 STAFFING FOR PSYCHIATRIC 

OR SUBSTANCE ABUSE SERVICES 

(a) G e n e ral. 

(4-) A physician shall bo present in the 

faoility or on oall 2 4 hours p e r day. 
The — m e dical — appraisal — sad — m e dioal 
tr e atm e nt of e ach pati e nt shall b e th e 
responsibility of a physician. 

(2) Eaoh faoility shall det e rmin e its ov e rall 

staffing r e quir e m e nts bas e d upon th e 
ag e cat e gori e s (child, adol e sc e nt, adult, 

e ld e rly), olinioal oharaot o ri s tio s , 

tr e atm e nt r e quir e m e nts and numb e rs of 
pati e nts. 

(3} Th e r e s hall b e a sufficient number of 

appropriat e ly — qualifi e d — olinioal — aed 
support s taff to ass e ss and addr e ss th e 
olinioal n e ed s of the pati e nts. 

(4) Staff m e mb e rs shall hav e training or 

e xperience in the provision of oare in 
eaoh of the age categories assigned for 
tr e atm e nt. 
(ft) — Psychiatric Services. 

(4-) Staff cov e rage for psyohiatrio s e rvio e s 

shall inolud e at l e ast on e e aoh of th e 

following: psychiatrist, — psyohiatrio 

nurse, psychologist, and a psyohiatrio 
sooial work e r. 

(2) A qualifi e d m e ntal h e alth prof es sional 



shall b e r e adily availabl e by tolophti 
or pag e and able to r e aoh the fao il 



m- 



within 30 minut e s on a 24 hour bast 



Eaoh — olinioal — ef — dir e ot — oaro - 



m e mb e r who is not a qualified men 



h e alth prof e ssional shaH peeei 



prof e ssional sup e rvision from - 

qualifi e d m e ntal h e alth prof e ssional. - 



(44- 



Wh e n — detoxification — s e rvioo s- 



provid e d, th e r e shall b e liaison 



consultation with a qualified subotan 



abus e — prof e ssional — prior — te — t 



disoharg e of a cli e nt. 
(e) — Substano e Abus e S e rvio e s. 
(44 At l e ast on e r e gist e r e d nurse shall bo 






duty during e ach shift. 
(3) C e rtifi e d couns e lors ef — qualifr 



substano e abus e prof e ssionals ohall 



e mploy e d — at — the — fatie — of one oti 



member — fef — eaeh — tea — inpatients 



fraction — th e r e of. 



4n — document * 



instanc e s — of bona — fide — shortages 



o e rtifi e d p e rsons, unc e rtifi e d individuo 



e xp e cting to b e com e c e rtified may I 
employed for a maximum of 3 8 montl 



without qualifications. 
(3) Th e hospital shall have a minimum 



twe — staff — m e mb e rs — providing — eas 



treatm e nt — aad — s e rvio e s — dir e otly 
pati e nts — en — duty — at — aH — tim e s « 
maintain — a — shift — fatie — of on e otn 



memb e r for e ach 20 or l e ss inpation 
with the following exceptions: 



(A) — Wh e n th e r e ar e minor inpati e nts th e r 
shall b e staff availabl e on th e ratio ( 



one staff member for eaoh 5 mine 



inpati e nts or fraction th e reof durini 
each shift from 7:00 a.m. tW) 



(B) — Wh e n d e tox s e rvio e s ar e off e red ther 



s hall b e no l e ss than one staff memb e 



for e aoh 



fractio 



<44- 



nin e inpati e nts or 
th e r e of on e aoh shift. 
-A certifi e d substano e abu s 



couns e lor/sup e rvisor shall bo omploy e < 
in aooordanc e with r e quirements of th ' 
North — Carolina — Substano e — Abus i 



Prof e ssional C e rtification Board whe i 



th e Board's certification rcquircmonti 



go into eff e ct, but a c e rtified subatono t 
abus e — couns e lor/supervisor — shaH — hi 



r e quir e d no e arli e r than January 1 - 

4Wr 



Statutory Authority G.S. 131E-79. 



1734 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



0916 PSYCHIATRIC OR SUBSTANCE 
ABUSE SERVICES RECORD 
REQUIREMENTS 

(a) — Id addition to th e general r e cord k ee ping 
equiromontfl of Rul e 10 NCAC 3C 4404, 



pooializod assessm e nt and treatm e nt plans for 



ndividuals und e rgoing poychiatrio or substanc e 



buoo tr e atment ar e as follows: 



mbstano e abus e pati e nts s hall b e d e v e lop e d in 
lartn e rship with th e pati e nt or individual aoting in 



(4) Within 2 4 hours following admission 

eaoh individual shall hav e a compl e t e d 

admission — ass e ssm e nt. The — initial 

assessm e nt shall includ e the r e ason for 
admission, admitting diagnosis, m e ntal 
s tatus — including — suioid e — pot e ntial, 
diagnostic t e sts or e valuations, and a 
determination of the need for additional 
information to includ e th e potential for 
the physical abus e of s e lf or oth e rs and 
a family ass e ssm e nt wh e n a minor is 
involved. 

(2) Within 72 hours following admissions a 

pr e liminary individual treatment plan 
shall b e compl e t e d and implemented. 

(3) Within — tea — days — following — inpati e nt 

admission a compreh e nsiv e individual 
treatm e nt plan shall b e d e v e lop e d and 
impl e m e nt e d. — For outpatient programs 
the — plea — sbaH — be — d e v e lop e d — and 
implem e nt e d — within — 30 — days — ef 
admission to tr e atm e nt, 
(b) Individual tr e atment plans for psychiatric and 



)ohalf of th e pati e nt. — Clinioal r e sponsibility for 
ho dev e lopment and implementation of the plan 



hall b e d e arly designated. Minimum components 
)f th e compr e h e nsiv e tr e atm e nt plan shall includ e 



liagnosis and tim e sp e cific short and long t e rm 



n e asurable goals, strat e gi e s for r e aching goals, 



ind staff r e sponsibility for plan impl e m e ntation, 
rh e plan shall be revised as m e dically or olinioally 
ndioat e d. 



(e) — Progress not e s shall b e e nt e r e d in e aoh 
ndividuaT s r e oord. Included is information which 



nay hav e a significant impaot on th e individual's 
ondition or e xp e oted outcom e suoh as family 



ionforono e s or major e v e nts r e lat e d to th e pati e nt. 
foti e nt status shall b e docum e nt e d eaoh shift for 
tay — inpatient — psychiatric — e* — substanc e — abus e 



l e rviooa, and on a p e r visit basis for outpati e nt 
jsyohiatrio and substanc e abus e servioos. 



(d) For eaoh individual to whom substanc e abus e 
g e rvioos are provid e d, a written plan for aft e roare 



9 e rvioos shall bo d e v e lop e d whioh minimally includ e s: 
(4) plan for d e livering aft e roar e se rvio e s, 



m- 



inoluding th e afteroare services whioh 

ar e provid e d; and 

provision — fef — agroomonts with 



individuals or organizations if aftercare 
s e rvio e s ar e not provid e d dir e ctly by 
th e faoility. 

Statutory Authority G.S. 131E-79. 



.0917 COMPLIANCE WITH STATUTORY 
REQUIREMENTS 

{a) — Faciliti e s providing psyohiatrio or substanc e 
abus e s e rvio e s shall d e v e lop proc e dur e s to en s ure 
the — rights — of psyohiatrio — and — substanc e — abus e 
pati e nts in accordanc e with North Carolina statut e s 
addr e ssing the rights of psyohiatrio and substance 
abuse patients. — Statutes addressing suoh rights ar e 
as follows: 

(4) G.S. 122C 51. — Declaration of policy 

on cli e nts' rights; 

(2) G.S. 122C 52. Right to confid e ntiality; 



(3) G.S. 122C 53. Exceptions; cli e nt; 

{4) Gt& — 122C 54. Exc e ption s ; abuse 

reports and oourt proce e dings; 
{5) G.S. 122C 55. — Exceptions; care and 

tr e atm e nt; 
(6) GtS: — 122C 56. — Exc e ptions; r e s e arch 



m- 



m- 



and planm egf 

G.S. 122C 57. Right to tr e atm e nt and 

cons e nt to tr e atment; 

G.S. 122C 5 8 . — Civil rights and civil 

r e m e di e s; 
(9) Gt* — 122C 59. U se of oorporal 

punishm e nt; 
(40) Gt& — 122C 60. Use of physical 

r e straints or seclusion; 
(14) G.S. 122C61. Treatm e nt rights in 

2 4 hour faciliti es ; 
(42) G.S. 122C 62. Additional rights in 



2 4 hour faoiliti e s; 

(13) G.S. 122C 65. Off e ns es r e lating to 

oli e nts; and 

(44) G.S. 122C 66. Protection from abus e 

and e xploitation: r e porting. 
(te) — Faoiliti e s providing psyohiatrio or substano e 
abus e s e rvio e s shall d e v e lop proc e dur e s to prot e ct 

confid e ntiality ef- — information r e garding 

oommunioabl e dis e as e aad conditions ifi 

oompliano e with G.S. 130 A 1 4 3. 



Statutory Authority G.S. 131E-79. 

SECTION .1000 - EMERGENCY 
AND OUTPAnENT DEPARTMENTS 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1735 



PROPOSED RULES 



Statutory Authority G.S. 131E-79. 

.1003 EMERGENCY PROCEDURES 

{a) — A r e oord shall be made of each patie 



e xamin e d — ef — tr e at e d — t-a — the — e m e rg e ncy root 



including — date; — nam e , — addr e ss, — age; — plaoo - 



injury, diagnosis, tr e atment and diopooition. The 



r e cords — shall b e filed in th e modioal rooo* 



departm e nt as p e rman e nt records. 



<&- 



41 — anesth e sia, — oth e r — thaa — looaL - 



administer e d — m — the — e m e rg e ncy — room, — t) 



provisions of S e otion .1200 of this Subohapt 
s hall be ob se rved. 

Statutory Authority G.S. 131E-79. 

.1004 POISON CONTROL 

(a) — Trie looation and telephon e numb e r of tl 



.1001 EMERGENCY FACILITIES 

(a) — Hospitals shall have an em e rg e ncy s e rvic e 
with faoiliti e s to mo o t the hospital s e rvic e s to b e 
provided. At least on e room shall b e continuously 
available for the r e o e ption, e xamination and initial 
tr e atm e nt of em e rg e ncy pati e nts. — This room shall 
b e independent of th e op e rating room suit e . 

(b) — Adequat e suppli e s and e quipm e nt s hall b o 
availabl e and in r e adin e ss for us e . — Faoilities shall 
b e available for th e administration of blood, blood 
plasma and intrav e nous m e dioation as w e ll as 
faoilities for th e oontrol of bl ee ding, e m e rgenoy 
splinting of fractures, and th e administration of 
oxyg e n, anesthesia and suction. 

(c) Appropriat e drugs and solutions, as sp e cifi e d 
by — the — m e dioal — staff, — shaH — be — imm e diat e ly 
availabl e . 



Statutory Authority G.S. 131E-79. 

.1002 EMERGENCY ORGANIZATION 

(a) — Th e m e dioal staff s hall provid e for prompt, 
comp e t e nt m e dioal att e ntion for all e m e rg e noy 
patients as th e ir r e sp e ctive needs may dictate. 
This plan shall inolud e provisions for sp e cialist 
consultation — as — weH — as — initial — r e c e ption — and 
e valuation of pati e nts. 

fb} — Sch e dul e s, names and t e l e phon e numb e rs of 
all physicians and others on emergenoy oall duty, 
including alt e rnat e s, shall b e maintain e d. 

(e) — The medioal staff shall assure its e lf of th e 
comp e t e nc e of all physicians having e m e rgenoy 
room duti e s, — and — shaH — provid e for — n e c e ssary 
r e fr es h e r training. 

{4} On e or mor e lio e ns e d — nurs e s shall b e 

assign e d to e m e rgency room duty at all times. 

This assignm e nt n ee d not b e exolusive of oth e r 

duti e s, but must hav e priority over all other duties 

when e v e r a patient is brought to th e e m e rgency 

departm e nt. — Alt e rnat e s shall b e provid e d in ord e r 

that th e coverage will be continuous. — R e gular and 

alt e rnate personn e l, if assigned oth e r duties, shall 

b e station e d within e asy r e aoh of th e e m e rg e noy .1006 OUTPATIENT DEPARTMENT 

room. ,•■..-. 

{&) — All e m e rg e noy room p e rsonnel s hall r e o o ivo 
ori e ntation and training in th e r e c e ption and oar e 
of e m e rg e noy pati e nts. 



n e ar e st poison oontrol oont e r shall b e pootod f 
imm e diat e r e fer e nc e . 

(b) A list of poison antidot e s shall bo maintain< 
ifl — the — hospital — aad — shaH — be — post e d — in tl 
em e rg e noy room. 



Statutory Authority G.S. 131E-79. 

.1005 DISASTER AND MASS 
CASUALTY PROGRAM 

(a) — Eaoh hospital, through joint e ffort of tl 



gov e rning board, administrator, m e dioal staff, ai 
hospital p e rsonn e l, shall dev e lop a written diBasti 



and mass oasualty plan for th e r e ception, treatm e : 
aad — disposition — ef- — casualti e s — from — a — sag- 



oatastroph e . — Th e program may be work e d out 
coop e ration with oth e r hospitals of th e area ai 



with other concerned ag e noies. 



(b) This program s hall inolud e th e possibility 
disast e r involving loss of the hospital or scrioi 



impairm e nt of its facilities. 
Statutory Authority G.S. 131E-79. 



(a) — Faoilities. — Wh e r e outpatient services ai 



maintain e d, th e typ e and quantity of faoiliti e s sha 
b e suoh as to provid e safe, prompt Gcrvioo to tl 



0) Compl e te — lists — ef- — s tandard — equipment, 

s uppli es , — and — proc e dur es — applying — te — the 
e m e rg e ncy room shall be in writing and oopies 
th e r e of shall b e post e d in th e e m e rg e ncy room or 

suit e . 



number and typ e s of patients s e rv e d. 
{b) — Organization 



(4-) Only m e mb e rs of th e m e dical staff 

the — hospital — shall — be — permitt e d — t 



practice in th e outpati e nt sorvio e , or 



(g) An emergenoy room proc e dure manual shall 
b e pr e par e d for r e f e r e nc e in th e emergenoy room. 



th e privileges of physicians and donti s 1 
m — the — outpati e nt — s e rvic e — shaH — fe 



d e fin e d in terms of th e ir training an 



ability, in th e sam e manner as th e 



1736 



NORTH CAROLINA REGISTER 



February I, 1995 



9:2 



PROPOSED RULES 



privilege s in th e inpatient aerviooo. Th e 
governing — board — may — cr e at e — sp e cial 
oatogori es of staff memb e rship, limit e d 
to praotioo in the outpati e nt se rvice. 

(3) Nursing p e r s onn e l shall b e pr e s e nt in 

suffici e nt numb e r to r e nd e r ad e quat e 
sorvio e to patients and phy s icians. 
(o) Procedur e s. — Adequate and complet e r e cords 



i hall b e k e pt on all outpati e nts. — Th e s e r e oord s 
i hould — oontain — suffici e nt — id e ntification — data, 



ii s tory, — and — reports — of all — examinations — asd 
roatmonto. — Th e r e oords shall b e r e adily availabl e 



ef — referenc e — upon — subs e qu e nt — inpati e nt — of 



Statutory Authority G.S. 131E-79. 

SECTION .1100 - PHYSICAL 
MEDICINE 

1101 PHYSICAL THERAPY 

Hospitals whioh provid e physioal th e rapy s e rvic e 



hall, regardl e ss of th e scop e of such s e rvic e , 
istablish — asd — e nforo e — polici e s — ef- — op e ration 



noluding the following: 

£t) The servic e shall b e sup e rvis e d by a 

lic e n se d physioian or oommitt ee of th e 
m e dical staff. 



{3) Proc e dur es and tr e atm e nts shall b e giv e n 

only on the written ord e r of a m e mb e r of 
th e m e dical staff. 

(3) R e oords shall b e maintain e d of all ord e rs, 



proc e dur e s, — and — tr e atm e nts, — and — fef 
inpati e nts, s hall b e mad e a part of th e 
medioal r e oord. 



(4) Saf e ty — policies — shall — be — established 

r e garding us e of e quipm e nt and handling 
of pati e nts. 

tatutory Authority G.S. 131E-79. 

1102 OCCUPATIONAL THERAPY 

Hospitals whioh provid e oooupational th e rapy 



e rvio e shall, — r e gardl e ss — of the soop e of such 



e rvioo, establish and e nforo e polioi e s of operation 



noluding th e following: 

{!) Th e s e rvice shall b e s up e rvis e d by a 



m- 



lic e ns e d physioian or oommitt ee of the 

m e dioal staff, and s hall b e administer e d 

by — prop e rly — qualifi e d — oooupational 

th e rapists. 

Proc e dur e s and tr e atm e nts shall b e given 



m- 



only on th e written ord e r of a member of 
th e m e dioal staff- 
R e cords shall bo maintain e d of all ordors, 



proc e dur e s — aed — tr e atm e nts, — and — fef 
inpati e nts, shall b e mad e a part of the 
m e dioal record. 

{4) Saf e ty — polioi e s — shall — be — es tabli s hed 

r e garding us e of e quipm e nt and handling 
of patients. 

Statutory Authority G.S. 131E-79. 

SECTION .1200 - ANESTHESIA 

.1201 FACILITIES 

(a) In th e surgical d e partment or Division of any 
hospital, th e r e shall b e faciliti e s and e quipm e nt for 
th e administration of anesthesia, — commensurat e 
with the ne e ds of th e hospital. 

{b) — Construction, storag e , and e quipm e nt shall 
b e in aooordano e with the standards of the National 

Fife Prot e otion Association (N.F.P.A.), 

incorporated in Bull e tin No. 56, "Cod e for th e Us e 
of Flammabl e Anesthetics," dated May, 1962 or 
subs e qu e ntly. 

Statutory Authority G.S. 131E-79. 

.1202 ORGANIZATION 

(a) — Th e administration of g e n e ral or regional 
an e sth e sia or analg e sia shall b e p e rform e d only by 
physioians or nurs e s approv e d by th e medioal staff 
on th e basis of an e valuation of th e ir training, 
e xp e ri e nc e and ability and in the cas e of physicians 
sp e cifically appoint e d to — such praotio e by th e 
gov e rning board. 

<b) — Suoh approv e d p e rsonn e l shall b e available 
at all tim e s in suffici e nt numb e rs to m ee t th e n ee ds 
of th e hospital. 

(o) Th e an e sth e sia d e partm e nt shall b e under th e 
sup e rvision — of a — full tim e — an e sth e siologist — of 

consulting — an e sth e siologist. If- — eely — nurse 

an e sthetists — ar e employed, — m e dioal — sup e rvision 
shall b e provid e d by th e chi e f of surgioal s e rvio e 
or by an alt e rnat e member of that servic e . 



Statutory Authority G.S. 131E-79. 

.1203 PROCEDURES 

(a) Pr e op e rativ e Proc e dur e s. Op e rations under 
a g e n e ral an e sth e tic (inhalation, spinal, intrav e nous 
or r e otal) s hall not b e p e rform e d nor a g e neral 
an e sth e tio giv e n until th e pr e operativ e proc e dur e s 
outlin e d in Rul e .0903 of this Subchapt e r, hav e 
boon oompli e d with. 

{b) Exception. Any — of th e — pr e op e rative 

proc e dur e s may b e waived, if in th e judgm e nt of 
th e att e nding physioian or surgeon, th e risk of 



•21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1737 



PROPOSED RULES 



d e lay endang e rs th e pati e nt's lif e , 
(o) R e cov e ry 

(4-) Pati e nts — und e r — e* — r e cov e ring — from 

an e sth e sia shall r e main und e r 

continuous, dir e ot nursing supervision 
until vita] signs have becom e stabilized. 

43) Any nurs e p e rforming this duty shall 

have been instruct e d in the management 
of post an e sthetic pati e nts, shall hav e 
no oth e r duties during th e tim e sh e is 
sup e rvising — sueh — patients, — aad — shaH 
hav e — imm e diat e — r e cours e — te — the 
att e nding surg e on or anesthesiologist, 
or qualifi e d substitute, pr e s e nt in th e 
hospital. 

Statutory Authority G.S. 131E-79. 



.1204 PROTECTION AGAINST 

ANESTHETIC ACCIDENTS 

<*) — The hospital shall r e cogniz e th e dangers of 
accid e ntal ignition of anesthetic gas e s to pati e nts 
and oth e rs and shall mak e provisions to minimize 
this hazard in accordance with the National Fir e 
Prot e ction Association standards oit e d abov e . 

(b) Persons administering anesth e sia shall ch e ck 
te — asc e rtain — feat — anosthotio — gas — cylind e rs — afe 
prop e rly install e d on th e anesthesia machin e s and 
that all cylind e rs and machin e valv e s ar e properly 
labeled or color cod e d. 

(c) All anesthesia machines shall incorporate pin 
ind e xing — in the — int e r e st — of avoiding — improp e r 
installations of gas cylinders. 



Statutory Authority G.S. 131E-79. 

SECTION .1300 - PHARMACY 

.1301 FACTLITIES 

(a) Hospitals — op e rating — aed — maintaining — a 

pharmacy as d e fin e d by G.S. 90 8 5.3 shall have 
ad e quat e — spac e — and — faciliti e s — fef — storage 
compounding and disp e nsing of drugs. — All areas 
shall be w e ll illuminated. 

(b) All pharmacies , without regard to th e e xt e nt 
and — fr e qu e ncy — of sup e rvision — by — a r e gist e r e d 
pharmacist, shall b e regist e r e d with th e North 

Carolina — Board of — Pharmacy : (Informat iee 

conc e rning — r e gistration — proc e dures — may — be 
obtained — from — the — North — Carolina — Board — ©f 
Pharmacy, P.O. Box H, Carrboro, North Carolina 
27510.) 

(e) — Th e r e shall be refrig e ration for biologicals 
and such drug produots whioh r e quire refrigeration. 



Statutory Authority G.S. 131E-79. 



.1302 ORGANIZATION 



{a) — A hospital pharmacy shall be under t 
sup e rvision of a full or part time qualified lioons 



pharmaoi st — register e d — m — fee — State — of No ; 



Carolina. — Drugs, m e dications and poisons boo t 



in areas of th e hospital oth e r than the pharma 



shall lik e wis e b e und e r th e general sup e rvioion - 
th e registered pharmaci s t. 
fb) — A pharmaoy oommitt ee to give advice 



pharmaceutical — problems — shaH — be — e otablioha 



Such committe e s shall moot at regular intervals a 



th e m e mbers shall b e chos e n from th e aovc i 



Divisions of the m e dioal staff as well as inolu . 



th e hospital pharmaoist and administration. 
Statutory Authority G. S. 131E-79. 

.1303 PROCEDURES 

(a) The hospital shall us e drugs, oh e mioala, ai 



pharmaceutical pr e parations whioh m ee t quali 



standards — of th e — Unit e d — Stat e s — Pharmaoo pei 
National Formulary, New and Non Official Drug 



or oth e r r e cognized compendia. 
{b) — All m e dicines, poisons, and stimulants kc 



on nursing units shall b e plainly lab e l e d and star 
in a sp e cially design e d, well illuminated modioli 
cabinet, closet, or storeroom, and mad e aoo e ssib 



only to authorized personnel. 



fe>- 



Suitabl e — control — asd — records — shall 






maintain e d — fef — fee — safe k ee ping — and — prep 
utilization — ef- — those — c e ntral — nervous 



syste 
stimulants — used — fef — mood — modification — m 



barbiturat e s us e d for hypnotio and somnifaoie 



purposes — as — requir e d — by — North — Carolina ai 



f e deral laws or as dictated by considerations 
safe pharmaoy practic e . 
{d) — Ther e shall b e an automatio stop ord e r ( 



dang e rous drugs. Drugs whioh — fall into th 

classification are narcotios, antibiotics, s e dativ 



and — hypnotics, — and — anti coagulants. Ho spit 



policy in this matter shall b e developed by tl 
m e dioal staff and parallel the recommendations 
fee — Joint — Commission — en — Accreditation 



H e althcare Organizations. 
{e) — When orders have b ee n discontinued or tl 



patient discharg e d, all of his m e dications shall 1 



discard e d, r e turn e d to th e pharmacy, or disoharg i 



with th e pati e nt aooording to th e doctor's orders 
ff) — If narcotics that ar e administered from tl 



hospital stock ar e prooured under a federal pormi 



e aoh dos e shall b e r e cord e d on a porm afle 
norootio record, whioh, in aooordanoo with f e d&f 



r e gulations, must provid e the date, hour, naa e- 



1738 



NORTH CAROLINA REGISTER 



February 1, 1995 



9: 



PROPOSED RULES 



ationt, kind of narootio, dos e , and by whom 
dminiotored. — If a narootio is administ e r e d from 
a outside — prepar e d — proscription, — it — shaH — be 
iffioiont to rooord e aoh dos e on th e olinioal 
i oord of the pati e nt. 



{g) — Narootios must be s e cur e ly look e d at all 
moo and aooosoibl e only to authorized p e rsons. 



(h) Suitable and proper r e cord s s hall b e k e pt of 
10 transactions of the pharmaoy as required by 



lorth Carolina and f e d e ral laws or as dictat e d by 



Dnsidorations of saf e pharmaoy praotio e . 



11 modioal records. 



{e) — If modioal r e oords ar e stor e d in a se parat e 
uilding, it shall bo of fire r e sistive construction. 



tatutory Authority G.S. 131E-79. 

1402 ORGANIZATION 

The responsibility for sup e rvising, filing and 



tatutory Authority G.S. 131E-79. 

SECTION .1400 - MEDICAL 
RECORDS 

1401 FACILITIES 

(a) — Tho m e dical r e oords d e partm e nt shall b e 



onvoniontly looat e d. 

(b) Provisions shall b e mad e for saf e storag e of 



idoxing of m e dical r e oords shall b e d e l e gat e d to 
train e d — m e dioal — r e cords — librarian — of — te — a 



^s ponsible e mploy e e of th e hospital . 
tatutory Authority G.S. 131E-79. 



1403 PROCEDURES 



(a) A system of filing and ind e xing according to 
n e of th e acc e ptabl e — nom e nclatur e s — shall — be 



dopt e d. 

{b) — M e dioal records shall b e ind e x e d for: — the 



ationt, — the — dis e as e , — the — m e dioal — e* — surgioal 
roo e dure involved, th e physician, th e r e sults and 



ny other p e rtin e nt information doom e d n e c e ssary 
y tho modioal staff. 



(o) A memb e r or committ ee of memb e rs shall b e 



ppointod by th e modioal staff to asc e rtain wh e th e r 
l e modioal records ar e ad e quate and up to date, 



nd to formulate rul e s and r e gulations and assist in 
l e ir enforc e m e nt. 



(d) — R e oords of pati e nts are th e prop e rty of th e 



ospital and must not b e tak e n from th e hospital 



xo e pt und e r a subpoena. — Wh e n tak e n from th e 



o s pital property under subpo e na, th e y must be 
e turnod to tho hospital at th e e nd of th e h e aring 
>r whioh th e y w e r e directed to b e procur e d. — As 



administrativ e offioor shall b e responsibl e for tho 
enforcem e nt of this Rul e . 

(e) — It is the responsibility of th e hospital to 
saf e guard th e information on th e r e cord against 
loss, tamp e ring, or use by unauthoriz e d p e rsons. 

(f) Only a physician, member of th e house staff, 
physician assistant or nurs e practitioner is allowed 
to write or diotat e m e dioal hi s tori e s and physical 
examinations. — Th e us e of a physician assistant or 
nur se pmotition e r in p e rforming th e s e aotivities 
must b e approv e d by th e hospital's gov e rning body 

and modioal staff. If m e dioal histori e s and/or 

physical examinations ar e p e rformed by a physi 
oian assistant or nurs e praotitioner, h e or sh e mu s t 
b e approved to p e rform suoh s e rvices und e r th e 
lic e ns e of th e physician or group of physicians 
r e sponsibl e for his or h e r m e dioal acts as approv e d 
by th e Board of M e dioal Examiners of th e Stat e of 
North — Carolina — und e r — G e n e ral — Statut e — 90 1 8 . 
Hi s tori e s and phy s icals p e rform e d by a physician 
assi s tant or nurs e praotition e r must b e count e r 
sign e d by th e r e spon s ibl e physioian(s) . 

Statutory Authority G.S. 131E-79. 

.1404 CONTENT 

(a) Ad e quat e and compl e t e m e dioal r e oords shall 
b e writt e n for all pati e nts admitt e d to th e hospital. 
Th e s e r e oords s hall b e fil e d in an ord e rly and 
acc e ssibl e mann e r in th e hospital. 

{b) — A minimum m e dioal r e cord shall contain 
suffici e nt — r e corded — informati on — te — j u s tify — the 
diagnosis, v e rify th e tr e atm e nt and warrant th e e nd 
r e sults. — It shall includ e th e following information: 



w- 






Id e ntification data (name, address, ago, 
s e x, marital status); 
Dat e of admission; 



Dat e of di s charg e ; 



{4) P e rsonal and family history; 






Chief complaint; 
History of pr e s e nt illn e ss; 
Physical e xamination; 



Sp e cial e xamination, if any, suoh as: 
oon s ultation s , olinioal laboratory, x ray; 

(9) Provisional or admitting diagnosis; 

(40) Medioal treatm e nt (signed or initial e d 

by p e rson giving th e m e dioation or 
tr e atm e nt); 

(44) Th e surgical r e cord shall includ e : anes 

th e sia r e cord, pr e op e rativ e diagnosis, 
op e rativ e — proc e dur e — and — findings, 
post operativ e — diagnosis, — and — tissue 
diagnosis (on all sp e cim e ns e xamin e d); 

f42) Progr e ss and nurs e not e s; 

(43) T e mp e ratur e chart inoluding puls e and 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1739 



PROPOSED RULES 



respiration, m e dioations; 

<44) Final diagnosis; 

{44) Summary' and oondition on disoharg e ; 



&*■ 



In oas e of d e ath 
p o rform edr 



autopoy findings, if 



(e) The m e dioal r e cord must be compl e t e d 

within a r e asonable tim e after the disoharge of th e 
pati e nt and th e compl e tion is the responsibility of 
th e att e nding physician. 

Statutory Authority G.S. 131E-79. 

.1405 RETENTION OF RECORDS 

All original m e dioal r e cords or photograph s of 
such r e cords shall b e pr e s e rv e d or r e tained for at 
l e ast the period outlin e d in th e North Carolina 
Statut e of Limitations and in acoordano e with 
hospital policy based on Am e rioan Hospital Asso 
oiation — r e comm e ndations — aed — guidano e — of the 
hospital's l e gal advis e rs. 

Statutory Authority G.S. 131E-79. 

SECTION .1500 - ACCOMMODATIONS 
FOR PATIENTS AND SPECIAL SERVICES 

.1501 ROOMS 

(a) — Each patient's room shall hav e an outsid e 
e xposure, b e dry, well v e ntilat e d and hav e th e 
requir e d window spac e and oth e rwis e b e suitabl e 
for oooupanoy. 

{fe) — No room shall bo used for b e d car e of 
pati e nts whioh oan only b e r e ach e d by passing 
through anoth e r pati e nt's room. 

(o) B e ds must b e plac e d at l e ast thr e e f ee t apart 
and must b e spac e d so as to provid e adequate 
room for nursing proo e dures and to pr e v e nt th e 
transmission of inf e ction. 

{&) — Window Ar e a. — Window ar e a shall b e at 
l e ast on e e ighth of th e floor ar e a. 

( e ) Doors to pati e nt rooms should b e suffici e ntly 
wid e to p e rmit e asy removal of th e occupi e d b e d 
with at l e ast a four inch ov e rall cl e aranc e . Vision 
pan e ls should b e plac e d in all doubl e acting doors. 
Solid oor e doors ar e r e quired so as to minimiz e th e 
spr e ad of fir e 



shall be provid e d for each patient. 
{¥) Gatoh b e ds or th e ir equivalent shall ■ 



provid e d unl e ss otherwise indioated by the typ e- 



m e dioal oondition of th e patient. 
(e) — Th e r e shall b e a bedside table for ow 



patient and at least on e chair in each patient root 



{d) — Eff e ctiv e moons of signaling nurses must 1 



provid e d within e asy reach of all patients. 
{e) — Soroons or ourtains shall b e provided - 



wards or multi bedrooms in order to s e ouro priv 



oy for e aoh pati e nt. All wards or multi bodrooi 



shall b e provided with oubiolo ourtaino or oquiv i 



l e nt e quipment whioh shall completely shield tl 



pati e nt. 



Statutory Authority G.S. 131E-79. 
.1503 BEDSIDE EQLTPMENT 



(a) Individual wash basins and mouth wash ou; 
shall b e provid e d for e aoh pati e nt. This oquipmc - 



shall b e plainly mark e d for e aoh pati e nt, stored i 



that it oannot b e int e rchang e d and shall bo stori 



iz e d wh e n th e pati e nt is discharg e d. — If individu 



b e dpans ar e not provid e d for pati e nts, each bodpi 
shall b e steriliz e d b e for e us e by another patient. 



(b) A olinioal th e rmometer shall be provided ft 
e aoh pati e nt and s hall b e st e riliz e d befor e e ach usi 



(o) Oxyg e n apparatus e ith e r for nasal oxygon 
oxyg e n t e nts shall b e provid e d. 



(d) A satisfactory b e d lamp shall b e provid e d 
e ach pati e nt' s b e d. 



(e) — Equipm e nt used near patients shall b e ad t 



quat e ly support e d or s e cur e d and prot e ct e d t 
avoid accident and injury. 

Statutory Authority G. S. 131E-79. 

.1504 CENTRAL SUPPLY AND 
STERILIZING 

(a) — Th e r e s hall b e provid e d suffici e nt steril 



supplies and equipment for all units of th e hoapiti 
to e nsur e that as e psis is maintain e d in carrying oi 



diagno s tic, treatment, and p e rsonal oare proo e 
dur e s. 



{b) Adequat e — oabinets, — cupboard s — or oth e 

suitabl e — spaces — shall — be — provided for ko e pin' 



— Storag e Spac e . Th e r e shall b e suitable st e ril e e quipm e nt and supplies in a oloan, oonv e 



m 

faoiliti e s for th e saf e storag e of olothing, toil e t 
articles, valuabl e s, and oth e r personal b e longings 
of the patients. 

Statutory Authority G.S. 131E-79. 

.1502 ROOM FURNISHINGS 

(a) A s e parat e b e d mattr e ss, pillow and b e dding 



ni e nt and orderly mann e r. - 



(o) All sterilization of suppli e s and equipm e nt t 



a hospital shall b e und e r th e dir e ot supervision oi 
a r e gist e r e d nurs e , or oth e r qualified person wh( 



has r e c e iv e d s p e cial training in this fi e ld. 

(d) Provisions shall b e mad e for p e riodic inap e o 
tion of all s t e rilizing e quipm e nt by a qualifie s 



person to e nsure that e quipm e nt operates effectiv e 



1740 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



y. Baotoriologioal m e thods shall b e us e d to oh e ok 
torilization — processes, — with — at — least — monthly 



mlturc oh e cks. 



Statutory Authority G.S. 131E-79. 

11505 UTILITY ROOMS 

(a) — Utility rooms shall hav e ad e quat e lighting 
tnd ventilation. Th e y — shaH — b e oonv e ni e ntly 



ooatod for th e e ffioiont oonduot of work. 



(b) If multi purpos e utility rooms ar e us e d, th e y 
i hall bo divid e d into oloan and dirty ar e as. 



dirty utility room area, or by water olo se ts with 
jodpan — flushing — attachments. The — bathtub, 



(e) — A bedpan hopper shall b e provid e d in eaoh 



avatory, or laundry tray shall not b e us e d for 
loaning the b e dpan. 



(d) Dietary it e ms ouoh as io e and food shall not 
x> stor e d in th e "dirty" utility room area. 



Statutory Authority G.S. 131E-79. 

1506 ISOLATION ROOMS 

{a) — Ther e shall b e availabl e a room or rooms 
which shall b e us e d for isolation of a patient or 



Dationto with oommunioabl e dis e as e . 



(b) Thooo rooms shall b e provid e d with hot and 
gold running wat ef; — soap dispens e r, — disposable 



towels, soil e d tow e l r e o e ptaol e , lavatory with oth e r 
than hand oontrols, lin e n hamp e r, and wat e r olos e t 



with b e dpan flushing attachm e nt. 

{«) — Patients with oommunioabl e dis e as e s shall 
not b e isolat e d in rooms which do not hav e th e 



faciliti e s outlin e d abov e in item numb e r (a) of this 
fi) — Isolation t e chniqu es shall b e in writing and 



fil e d at th e nursing station and shall vary aooording 
to wh e th e r th e dis e as e is transmitt e d by airborne 



infection, food born e infection, looal infootion, or 
pamsitio infection. 



( e ) In hospitals of 50 b e ds or mor e , at l e ast on e 



room shall be suitably e quipp e d for the temporary 
retention and car e of disturb e d pati e nts. 



Statutory Authority G.S. 131E-79. 

1507 INHALATION THERAPY 

(a) Wh e r e size of th e ho s pital — and usag e 

warranto, it is recommended that th e inhalation 



th e rapy service b e made a separat e d e partm e nt. 
Otherwis e , it shall b e a full tim e r e sponsibility of 



th e nursing, o e ntral steril e supply, or anesthesia 
d e partment. 

(b) — The administration of therap e utic ag e nts by 
th e aerosol route shall bo und e r the supervision of 



th e inhalation therapy s e rvio e . 

{©) AH — e quipm e nt — (masks, — catheters, — tents, 

r e gulators, e to.) shall b e und e r th e direct control of 
th e person r e sponsibl e for th e inhalation therapy 
s e rvio e . 

(d) Aft e r us e , all e quipm e nt shall b e returned to 
a o e ntral looation for thorough cl e aning, servicing 
and sanitizing b e twe e n patients. 

Statutory Authority G.S. 131E-79. 

.1508 VISITING OF PATIENTS 

{a) Eaoh — hospital — sbaH — establish — polici e s 

r e garding visiting for th e various s e rvic e s and 
d e partments of th e hospital . Such polici e s shall b e 
in writing and post e d in a promin e nt plac e . 

(b) Visitors with known infectious diseas e s shall 
b e e xclud e d from visiting any patient. 

Statutory Authority G.S. 131E-79. 

.1510 BED CAPACITY 

{a) — Th e r e shall b e no more bods n e t up and 
plac e d into us e in a hospital than th e number of 
b e ds for which it is lic e ns e d to maintain e xc e pt in 
th e oas e of a publio disast e r or national, stat e or 
looal e m e rg e ncy and then only as a temporary 
measure. — Th e numb e r of lio e ns e d b e ds shall b e 
d e t e rmin e d by th e Division in accordanc e with 
standards found in this Rul e . 

(b) For the purpose of d e termining b e d oapaoity 
the — following — squar e — feet — m e asur e ments — shflH 

apply, oxoluding spao e in — toil e t — rooms, 

washrooms, closets, vestibul e s, and oorridors: 



Typ e of Room/B ed- 
Single b e d 



Min. Sq. 
Ft. P e r Bed 
499 



Multi b e d 



-89 



Pediatric Crib 



-89 



P e diatric Nurs e ries/Bassin e t 49 

Adult Sp e cial Car e Units 139 



Infant Sp e cial Car e — 
(n e onatal)/Bassin e t 
Private /Rehab. Units 



-69 



459 



Multi b e d/R e hab. Units 



499 



(o) Th e following areas shall b e includ e d in b e d 
oapaoity: 

ft) bod spaoe in all nursing units including 

int e nsiv e oar e units, special care units, 
and minimal or self oare units; 
isolation units; 
p e diatric — units — including — pediatrics. 



m- 



m- 



bassin e ts and inoubators and n e onatal 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1741 



PROPOSED RULES 



units locat e d in pediatric d e partm e nt; 

{4) obs e rvation units equipped and otaff e d 

for ov e rnight us e . 
fd^ — Th e following ar e as shall bo o xoluded from 
b e d capacity: 

(4-) newborn nursery; 

(3) labor rooms; 

Q) r e oov e ry rooms; 

(4) emerg e ncy units; 

{§) preparation — ef — an e sthesia — induction 

rooms; 
(4) rooms — designed — and — e quipp e d — fer 

diagnostic and treatment purpos e s only; 

£7) hospital staff b e d ar e as; and 

{&) unfinish e d space. 



(e) — In establishing a maximum licens e d b e d 
oapaoity for e xisting, oooupied faciliti e s for th e 
first y e ar following th e e ffective date of this Rul e , 
e xt e nuating circumstanc e s shall b e consid e r e d. 

{4^ Bed oapaoity for faciliti es construct e d 

and occupi e d prior to Jun e 1, 1977, 
shall — be — determin ed — by — informati ee 
gather e d — through — oh — on site — survey 

conduct e d by an authorized 

r e pres e ntativ e of th e Division. 

(3) Bed — oapaoity — fef — faciliti e s — oooupi e d 

prior to — Juee — h — 1977, — but having 
construction — proj e cts — te — add — beds 
underway which wer e not completed 
and occupi e d prior to June 1, 1977, 
shaH — be — det e rmin ed — by — informati en 
gath e r e d — through — ae — on site — surv e y 

conducted by &e authoriz e d 

r e pr e sentativ e of th e Division — utilizing 
plans and sp e cifications approved — by 
th e Division. 



m- 



-Be4- 



capaoity for new or r e plac e m e nt 
faciliti e s oonstruotod and oooupi e d after 



Jw 



4t — 1977, — sfeaH — be — based — e* 



approv e d plans and sp e cifications or 
c e rtificat e of need approval, whiohev e r 
is l e sser numb e r. 

(4) Singl e b e d rooms with less than 100 

squar e — feet — floor — area — which — w e r e 
oon s truoted prior to th e e ffectiv e date of 
this — Rul e — shall — be — aooeptable — in 
hospitals wh e r e th e r e ar e no designated 
ov e rsiz e d single b e d rooms with a floor 
area — ef- — 1-60 — squar e — feet — ef — mor e - 
Rooms in e xc e ss of 159 squar e f ee t 
designated — as — oversized — singl e b e d 
rooms prior to th e e ff e ctiv e date of this 
Rul e shall r e main singl e bed rooms and 
shall not b e r e d e signated as multi b e d 



rooms — without — certificate — ef- — « 



approval, 
(f) B e d capacity for faciliti e s built, remodeled - 



add e d after th e effectiv e dat e of this Rulo ohall - 
d e termin e d by the minimum standards establi s h 



in this Rule in oonjunotion with c e rtificate of ih 



approval. 

Statutory Authority G. S. 131-126.5. 

SECTION .1600 - FOOD SERVICE 

.1601 FACILITIES 

(a) ¥be — extent — ef- — compliance — with 



regulations of th e Division of Health Sorvk 



pursuant to G.S. — 130A in r e gard to oanitati 



faciliti e s will b e tak e n into consid e ration by t 
Division of Faoility S e rvices in revi e wing faoilit 
under this Seotion. In aooordnnc e with e stablish 



policy, th e Division of H e alth S e rvic e s oxohanj 



information with th e Division of Faoility Sorvk 

conc e rning its sanitation insp e ctions. 

(b) — Th e r e shall b e ad e quate facilities for t 



prop e r — preparation — aed — s e rving — ef- — food 
d e t e rmin ed — by — th e size and — functions of t 



individual hospital. — Space and equipm e nt shall 



provid e d for r e c e iving and storage, prepaniti' 
and cooking, — s e rving, dining, dishwashing 



record keeping. 
{&) Tee — dietary — department — sbaH — iaek* 



faciliti e s for th e pr e paration of th e rap e utic di e ts 
{d} — Th e floors of kitch e n s , di e t kitoh e ns, dini 



rooms, and pantries, and tho floors of all roomo 
which food is stor e d, pr e par e d, or s e rv e d, or 
whioh — ut e nsils — afe — wash e d, — shall — bo of su 



construction as to b e easily cl e an e d, shall 



smooth, and shall b e k e pt in good r e pair. — ¥ 
walla and c e ilings of s uoh rooms shall have 



smooth washabl e surfao e , and shall be kept cl e < 
and in good repair. 



( e ) All rooms within th e di e tary d e partment oh 



b e so oonstruot e d as to pr e v e nt tho entrance of n 
and mic e . 



(f) All room s in which food i s s tored, prepar e 
or s e rv e d, and in which ut e nsils are washed, sh 



be — weH lighted, provid e d — with — ad e qufl 

ventilation, and screen e d against ins e cts. 



(g) Stor e rooms and oupboards, including sh e lv 
and racks, shall be oonstruot e d of e asily oloanabl 



smooth material, — and shall bo kept clean oi 



ord e rly. — Th e cont e nts of suoh rooms and otorq 
places shall b e n e atly stor e d at loaot 15 inch * 



abov e th e floor, and unn e cessary and oboole 



items shall not b e permitted to aooumulato th e rea 
{b) — All e ating, drinking, and oooking utens il 



1742 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



and all tabloo, shelves, refrig e ration e quipm e nt, 



s inlco, and other e quipm e nt or utenoilo us e d in 



ponnootion with th e hoflpital kitch e n, shall b e so 



oonstruotod ao to b e e asily clean e d, and shall b e 



kopt in good r e pair. 

{i) — All equipm e nt, including sh e lv e s, tabl e s, 
counters, rofrig e ratoro, stov e s, hoods, sinks, m e at 



blocks, potato poolers, grind e rs, slioing machin e s, 
s aws, and mix e rs shall b e k e pt cl e an and free from 



iast, — dirt; — insects, — and — oth e r — contaminating 



material. 



(j) — Singl e s e rvice articl e s construct e d of pap e r 
fiber, suoh as cups, plat es , straws, and caps on 



dietary produots, shall not b e r e us e d. 



Statutory Authority G.S. 131E-79. 

.1602 ORGANIZATION 

{a) — The di e tary d e partm e nt shall bo under th e 



s upervision of a train e d di e titian or a person 
skilled in th e handling, pr e paration and s e rving of 



foods and th e sup e rvision and manag e m e nt of food 



handl e rs. Th e latter may includ e supervision by a 
oontraot food s e rvice. 



(b) Whore a qualifi e d di e titian is not e mploy e d, 
the s e rvices of a qualified dietitian or nutritionist 



shall b e s e our e d p e riodically to consult with th e 



personn e l — of th e — di e tary — d e partm e nt — en — feed 
sorvio e proc e dur e s, suoh as th e storag e , proc e ssing 



and s e rving of food, th e planning of m e nus and th e 
manag e ment of th e rap e utic di e ts. 



{e) — Th e di e titian or p e rson in charg e of th e 
d e partm e nt — s hall, — with — the — approval — ef- — the 



administrator of th e hospital, initiate policies and 



proc e dur es with which e ach e mployee shall be 



familiar — and — those — shall — provid e — fef — the 
administrative — aad — t e chnical — guidono e — ef- — aH 
p e rsonn e l handling food. 



(d) R e cords shall b e kept so that compr e h e nsiv e 



information is maintain e d conc e rning th e typ e , 
quality, — and th e nutritional — ad e quaoy — of food 
s e rv e d to patients and p e rsonn e l. 



Statutory Authority G.S. 131E-79. 

1603 DISHWASHING PROCEDURES 

All dishes, knives, forks, drinking glass e s, cups 
and — other — e ating drinking — utensils — sheH — be 



thoroughly washed, rinsed, and subj e ct e d to a 
Division of H e alth S e rvic e s approved bact e ricidal 



tr e atment aft e r e aoh usage. All multi purpo se 



utensils, suoh as mixing bowls, cr e am disp e n se r s , 
stock pots and baking pans shall b e thoroughly 
cleaned and rinsed imm e diately aft e r us e . 



Statutory Authority G.S. 131E-79. 

.1604 FOOD SERVICE TO PATIENTS 
IN ISOLATION 
Dishes and ut e nsils which ar e us e d by patients in 
isolation b e caus e of communicabl e dis e ase shall bo 
subj e ot e d to a bact e ricidal proc e s s before being 
mix e d for washing with dish e s and uten s il s used by 
oth e r pati e nts. 

Statutory Authority G.S. 131E-79. 



.1605 STORAGE AND HANDLING 
OF FOOD 

(a) All food shall b e stored, handl e d, and s e rv e d 
as to b e protected from dust, fli e s, rats, v e rmin, 
handling, dropl e t infection, overhead l e akag e , and 
oth e r contamination. 

(b) — All moans necessary for th e e limination of 
fli e s and roaches shall b e us e d. 

(o) All r e adily p e rishabl e food or drink shall bo 
k e pt at or b e low 50 d e gr ee s F., e xc e pt when being 
pr e pared or serv e d. — All fr e sh m e ats, e xc e pt in 
small portions for immediate uso, shall b e stor e d 
at or below 4 degr ee s F. 

(4) — Grad e "A" milk produots shall b e us e d. 
Th e s e produots shall b e s e rv e d in th e original 
contain e rs in whioh th e y ar e receiv e d from th e 
distributor, s o that the nam e and grad e of the 
cont e nts, — and — the — nam e — ef- — the — produc e r — or 
distributor, — may — be — readily — obs e rv e d — by — the 

pati e nt. This r e quir e m e nt shall not apply to 

butt e rmilk whioh — is us e d strictly — for cooking 
purposes only. 

(e) — Milk produots shall b e stor e d in a sanitary 
mann e r and shall b e k e pt r e frigerated except when 
b e ing served. — Contain e rs shall not b e compl e tely 
subm e rg e d in wat e r. 

(f) — All food shall b e whol e som e and fr ee from 
spoilag e . — Food that is spoil e d or unfit for human 
consumption shall not b e k e pt on th e pr e mis e s. 

{g) — Portions of food ono e s e rv e d to pati e nts, or 
e mploy ee s, shall not be serv e d again. 



Statutory Authority G.S. 131E-79. 

.1606 EMPLOYEES 

(a) All e mploy ee s shall b e free of oommunioablo 
and — infectious — disease, — as — d e fin e d — in — G.S. 
130A 133, as it applies in e aoh work assignm e nt. 

{b) It — sheH — be — the — r e sponsibility — of th e 

manag e m e nt to require suoh insp e ctions and t e sts 
as often as are n e c e ssary to safeguard th e h e alth of 
th e pati e nt and oth e r employees. 

(e) AH — e mploy ee s — sheH — w e ar — clean — outer 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1743 



PROPOSED RULES 



garm e nts, and shall k ee p their hands ol e an at all 
tim e s wh e n handling food, — drink, utensils, — er 
equipm e nt. 

{4} F e mal e — di e tary — employees — must — w e ar 

hairnets and male dietary employees must wear 
eaps. 

{e) — Kitch e n employees shall not us e tobacco in 
any — form — while — engag e d — m — feed — handling 
op e ration s . 

Statutory Authority G.S. 131E-79. 

SECTION .1700 - PHYSICAL 
PLANT 

.1701 MAINTENANCE 

(a) — Th e hospital structure and component parts 
and facilities shall b e kept in good repair and 
maintain e d with consid e ration for th e saf e ty and 
comfort of th e pati e nt. 

{&) — Th e r e shall b e a definite assignm e nt of 
maintenanc e functions to qualifi e d p e rsonn e l und e r 
sup e rvision. 



Statutory Authority G.S. 131E-79. 

.1702 HEATTNG 

(a) Heating plants shall b e ad e quat e to maintain 
a cold w e ather t e mp e rature of 70 degr e es F. in all 
rooms us e d by pati e nts. 

Qd) — All boil e rs must meet requirem e nts of th e 
North Carolina D e partment of Labor. — Curr e nt 
c e rtificates — ef- — complianc e — must — be — prop e rly 
displayed. 

Statutory Authority G.S. 131E-79. 



.1703 ARTIFICIAL LIGHTING 

(a) Each pati e nt room shall hav e suffici e nt 

lighting — te — allow — the — physician — aed — nursing 
p e rsonnel to e xamine and tr e at th e pati e nt. — This 
shall b e no l e ss th e n 50 foot candl e s 36 inches 
abov e the floor. 

(b) Every room, including stor e rooms, hallways, 
and others shall hav e suffici e nt artificial light to 
mak e — aH — parts — clearly — visibl e — and to — p e rmit 
efficient performance of all necessary work. — This 
shall be no less than 15 foot candl e s at floor l e v e l. 

(c) All hallways, stairways, inclin e s, ramps, and 
e ntrances shall be well lighted. — This shall b e no 
less than 15 foot candl e s at floor lev e l. 



Statutory Authority G.S. 131E-79. 
.1704 EMERGENCY ELECTRICAL 



SERVICE 

(a) Em e rg e ncy el e otrio servioo is required. Thi) 



may bo mot by on e or a combination of tbt 
following m e thods: 

fH a — g e n e rating — plant — oth e r — than th & 



supplying th e main servioo, provide* 



m- 



th e resp e ctiv e transmission lines ok 

widely separat e d; 

an e m e rg e ncy g e n e rator on the hospit a 



<&- 



r e charg e abl e storag e batt e ri es . 



{&) The — e merg e noy — s e rvices — should bo ■ 



« 



arranged that in the e vent of interruption of norma 
service, the e merg e ncy system will — & 



automatically — plao e d in operation. Automatic 



switching e quipment must be of a typ e and 



-se 



interlock e d as not to p e rmit both normal and 



emergenoy — s e rvic e s — b e ing — conn e ct e d — tog e th o i 
through any operation of the automatic switohin| 
e quipm e nt. 
{e) As a minimum, th e following facilities 



should b e serv e d: 



£4-) lighting for operating, emerg e noy and 

deliv e ry rooms, exits and exit direction 



signs, — corridors, stairways, — nuroorioo, 
r e covery room, tel e phon e switchboard 



and boiler room; 



(3) nurs e s' oall syst e m, fir e alarm system 

incubators, respirators, — ets4 



@h 



refrigerators for m e dioal suppli e s, bone, 
blood and biologioals; 
heating plant; 



{4} conv e ni e nc e outl e ts in op e rating room; 



em e rgency — rooms, — delivery — rooms, 
r e cov e ry rooms, nurs e ri e s, and on e or 
mor e outl e ts on each nursing unit. 



{d) Em e rgenoy — el e ctrical — s e rvices — shall b e 



furnish e d in aooordanc e with ourrent applioabl e 
s e ctions of th e North Carolina Stat e Building Cod e 



and National Fir e Prot e ction Association Codes 



which are hereby adopted by ref e renoo pursuant to 
G.S. 150B H(o). 

Statutory Authority G.S. 131E-79. 

.1705 GROUNDING SYSTEM 



A prop e rly design e d e quipm e nt grounding system 
as well as an isolat e d from ground and detector 
monitor e d e l e ctrical source are essential to patient 



saf e r)' — aad — must — be — install e d — m — areas — whor e 
e lectronic equipment for coronary patients is us e d. 



Statutory Authority G.S. 131E-79. 
.1706 VENTILATION 



1744 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



(a) — Eaoh pationt'o room shall hav e at least on e 
indow; — op e ning — te — the — outaid e — te — p e rmit 



mtilation and a oouroo of natural light. 

£fe) — Kitohono, morguoo, bathrooms, and servic e 



oma ohall be looated and vontilat e d by window 



■ moohanioal d e vioeo to pr e v e nt offenoivo odoro 



om entering pati e nts' rooms and public halls. 



o hereby adopt e d by roforenoo pursuant to G.S. 
)0B 11(c). 



o) Rooms used for th e storago of flammable or 



m flamma ble — an e sth e tios — aad — rooms — wh e r e 



unmabl e — and — non flammable — an e sth e tios — are 



Iminioterod shall bo provid e d with v e ntilation in 



cordane e with th e curr e nt applicabl e sections of 



o North Carolina Stat e Building Code and the 



ational Fire Prot e ction Association Codes whioh 



{d) — A m e chanical air s upply system shall bo 
ovidod for year round usag e in op e rating and 



Jivory rooms. 



atutory Authority G.S. 131E-79. 



707 STAIRWAYS AND ELEVATORS 



{&) — Stairways ohall b e of a width and d e sign 
hioh will — e a s ily — aooommodato r e moval — of a 



itiont by str e tch e r and m ee t th e r e quir e m e nts of 



o State Insurano e D e partm e nt. 



(b) — Hospitals whioh hav e aooommodationo for 
iti e ntfl above th e firot floor ohall hav e an adequate 



imb e r of e l e vators servicing patient ar e as. 

(e) El e vators — and — machin e ry — shaH — be — ee 



instruct e d and maintain e d ao to comply with the 
i gulations of the North Carolina D e partm e nt of 
abor. 



tatutory Authority G.S. 131E-79. 



708 WATER SUPPLY 



at e r supply or a privat e supply s yst e m, — the 
cation, construction, and op e ration of whioh will 



(a) Th e wat e r shall b e obtained from a municipal 



>mply with the standards of th e North Carolina 
Hvision of Health S e rvic e s. 



&- 



-The — water — shaH — be — distribut e d — te 



Dnv e ni e ntly — looat e d taps — and fixtures — m — the 
uilding. 



(o) Ther e ohall b e an ampl e oupply of hot water 
mailable at all tim e s for g e neral use. 



(d) All di e tary ic e ohall be stor e d, handl e d, and 



> rv e d in a sanitary mannon — Ic e storage boxes, 
* — oooops, — buok e to — and — containers — shaH — be 



laintainod in good r e pair and kept oloan. — lee 
wop s , buok e to, containers, e to. , shall b e s tor e d so 



a not to b e oubjeot to contamination. — Ic e box e o 
lall bo covered. 



(e) — Dietary ioo ohall not b e stor e d in th e dirty 
utility room. 

(f) — Di e tary ic e ohall b e stor e d and transport e d 
only in covered contain e rs. 

Statutory Authority G.S. 131E-79. 

.1709 SEWAGE DISPOSAL 

Solid and liquid waste ohall bo dispos e d of in 
accordanc e with tho sanitation rul e s for hospitals 
oontain e d in 10 NCAC — 10A whioh are h e r e by 
adopted by r e ference pursuant to G.S. 150B H(o). 

Statutory Authority G.S. 131E-79. 

.1710 PLUMBING 

(a) All plumbing installed mu s t bo in accordance 
with th e North Carolina Building Cod e . 

(b) AH — plumbing — facilities, — whether — fef 

s t e rilization of ut e nsil s , in s trum e nts or suppli e s, 
g e n e ral wat e r supply or wa s t e di s posals, s hall b e 
install e d in such a mann e r as to compl e t e ly pr e vent 
possibility of oroos connections b e tw ee n saf e and 
unsafe suppli e s or baok siphonago. 

{©) — A toil e t room shall be dir e ctly acc e ssibl e 
from e aoh pati e nt room and from eaoh c e ntral 
bathing ar e a without going through th e g e n e ral 
oorridor. — On e toil e t room may serv e two patient 
rooms but not mor e than e ight b e ds. — Th e lavatory 
may b e omitt e d from th e toil e t room if on e is 
provid e d in e aoh pati e nt's room. 

(e) — One tub or shower shall be provid e d for 
e aoh 15 b e ds not individually s e rv e d. — Th e r e shall 
b e at l e ast on e bathtub acc e ssibl e on thr ee sides 
and on e show e r provid e d for e aoh 60 b e ds or 
fmotion th e r e of. 

Statutory Authority G.S. 131E-79. 

.1711 GARBAGE AND TRASH 
DISPOSAL 

(a) All garbag e shall b e handl e d and dispos e d of 
in accordanc e with th e ourr e nt minimum standards 
e stablished — by — the — Division — of Environm e ntal 
Health. 

(b) All trash s hall b e k e pt in suitable roooptaolos 
and s tor e d in a room design e d for trash storag e to 
m ee t th e ourr e nt minimum applioabl e standards 
e stablish e d by th e North Carolina Stat e Building 
Cod e . Trash accumulated during any on e working 
shift, in e aoh departm e nt, ohall b e ooll e ot & d at the 
e nd of that shift and stor e d in approv e d trash 
room(s). 

Statutory Authority G.S. 131E-79. 



:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1745 



PROPOSED RULES 



.1712 INCINERATION 

{a} — Incin e ration faciliti e s shall b e provid e d for 
disposal of infectious wasto in aooordanoo with 
Solid Wast e Manag e ment Rules 10 NCAC 10G 
which ar e h e r e by adopted by reference pursuant to 
G.S. 150B 116. 

fb) — Infectious wast e that is not inoin e rat e d shall 
b e st e rilized befor e b e ing placed in a g e neral wast e 
disposal system in aooordanoo with Solid Wast e 
Management Rules 10 NCAC 10G. 

Statutory Authority G.S. 131E-79. 

.1713 SCREENS 

All outside doors, windows and oth e r op e nings 
shall have eff e ctiv e protective measures against 
mosquito e s, fli e s, and oth e r ins e cts. — All scr ee n 
doors s hall op e n outward and b e equipp e d with 
se lf clo s ing d e vic e s . 

Statutory Authority G.S. 131E-79. 

.1714 HAND WASHING 

{a) Th e r e shall b e ad e quat e hand washing 

faciliti e s — within — ©f — conveni e ntly — looat e d — wits 
r e gard to every pati e nt's room or pati e nt oaring 
s e rvic e . 

{b) — Hand scrubbing sinks shall b e provided in 
s urgioal — asd — obst e trioal — suit e s, — labor — rooms, 
nurs e ri es , e xamining and tr e atm e nt rooms, and in 
rooms u se d in th e isolation of pati e nts. 

(o) Hand washing facilities must b e provid e d for 
feed — handl e rs — and — oth e r — hospital — employees. 
Notices pr e scribing th e washing of hands aft e r 
contamination — shaH — be — promin e ntly — post e d — m 
toil e ts, washroom s , and all food stations. 



Statutory Authority G.S. 131E-79. 

.1715 HOUSEKEEPING 

{a) — Hous e ke e ping faciliti e s and s e rvices are 
r e quir e d to b e such that comfortabl e and sanitary 
living conditions for pati e nts and e mploy e es are 
maintain e d constantly. 

{b) — Th e r e shall b e an ad e quat e number of 
janitor' s closets with mop r e c e ptors conv e ni e nt to 

all ar e as. Storag e of janitorial e quipm e nt and 

suppli e s shall be provid e d for in th e s e closets. 
Surgioal and obst e trioal suit e s shall hav e th e ir own 
janitor's olos e ts and cl e aning equipment. 

{©) — There must b e fr e qu e nt ol e aning of th e 
floors, walls, woodwork, and windows. — Dusting, 
swooping, and vacuum ol e aning shall b e p e rform e d 
in suoh a mann e r as to minimiz e th e s pr e ad of dust 
particl e s in th e hospital atmospher e . Accumulated 



wasto mat e rial must b e r e mov e d at least daily. - 
(d) Th e pr e mis e s must b e k e pt free from rodou 



and insect infestation. 
( e ) Bath and toilet facilities must be maintain e 



in a ol e an and sanitary oondition at all time s . - 
(f) — Writt e n proo e dur e s should be available -< 



hous e k ee ping p e rsonn e l. 
Statutory Authority G.S. 131E-79. 



.1716 LINEN 



(a) A — supply — of towels, — washcloths, — bat 

blank e ts, and all other lin e n which comes dirootl 



in contaot with the patient shall b e provided - 
needed for e ach individual patient. — No suoh line 



shall — be — int e rchang e abl e — from — one — patient 1 



another — b e fore — b e ing — properly — cl e aned — « 
laund e r e d. 



&T- 



B e dpan — cov e rs — shaH — set — be — ase 



interchang e ably. 
(e) — Th e r e shall b e a supply of olean linens t 



assur e th e cl e anlin e ss and saf e ty of th e pationti 
Particular att e ntion must b e giv e n to assuring 



supply of ol e an lin e ns during and after wookondi 
h olidays, and oth e r p e riods when the laundry 
not in op e ration. 



(d) Th e r e shall b e distinct s e parat e areas for th 
storag e and handling of ol e an and dirty linens. 



( e ) Equipment used to transport dirty linens sha 
not b e us e d to transport olean linens. — All line 



shall b e oov e r e d during transportation. 



{£) AH — dirty — lin e n hamp e rs — shall b e kep 

oov e r e d. 



Statutory Authority G.S. 131E-79. 

.1717 LAUNDRY 

(a) — Th e institution s hall make provision fo 



prop e r oleaning of linen and other washable gooc 
with sp e cial provision for handling oontaminat e 
lin e n. 



(b) Hospitals operating their own laundries sha 
id e v e ntilation for th e e limination of steam am 



prov 



odors — asd — prop e r — insulation — te — pr e v e nt — & 

transportation of nois e to patient areas. 

{e) — Wh e r e lin e n is s e nt to an outside laundr) 



th e administrator shall assur e that propor faoiliti e 
afe — availabl e — asd — methods — fef — handling — aft 



cleaning th e hospital lin e n are used as provided fo 
in Paragraph (a) of this Rul e . 

Statutory Authority G.S. 131E-79. 

SECTION .1800 - FTRE 
REGULATIONS 



1746 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



1801 STANDARDS 

{a) Fife — protection — standards — sbaH — be — » 

t ooordanoo with th e North Carolina Stat e Building 
2q4s — whioh — is — h e r e by — adopt e d — by — refer e nc e 



jurouant to G.S. 150B 1 4 (o). — In addition, th e y 



shall b e in aooordanoo with ourr e nt applioabl e 



tandards — ef- — the — National — Fife — Prot e ction 



Association Codes, whioh ar e h e r e by adopt e d by 



oforono e pursuant to G.S. 150B 1 4 (o) for: 
(4-) Installation, maintenance, and use 



«r 



firo extinguish e rs; 

{3) Use of flammabl e an e sth e tics; and 

(3) Uso of non flammabl e an e sth e tic s . 

(b) In addition, state and local fir e laws shall b e 
implied with. 



Statutory Authority G.S. 131E-79. 

.1802 MASTER PLAN AND FORE 
DRTLLS 

{a) — Each institution shall d e v e lop a mast e r fir e 
plan to fit the needs of the hospital. 



(b) — Employees shall b e train e d in the uso of 
firo fighting — e quipm e nt, — and — m — the — m e ans — ef 



rapidly e vacuating th e building by staff fir e drills. 
{©) — Drills shall b e h e ld quart e rly and at vari e d 

{$) — A writt e n r e cord of e ach drill s hall b e kept 
on file for a p e riod of on e y e ar. 



Statutory Authority G.S. 131E-79. 

1803 EXITS 

Th e r e — shsH — be — alt e rnat e — exitSj — m ee ting — the 



following sp e cifications from all oooupiod floors: 






a safo continuous e xit from th e int e rior of 
a building to a s tr ee t or oth e r op e n spac e s 
at grad e l e v e l conn e ct e d to a s tr ee t; 
r e mote location from oth e r e xits so that 



e ach e xit is readily acc e ssibl e and visibl e 
and arrang e d so that th e r e ar e no pock e ts 
or dead e nds, and no e xits oono e aled nor 
th e dir e ction to th e e xit obsoured by 
mirrors, drap e ri e s or oth e r objects; 



m- 



e xits maintained so as to 



id e free and 



prov 

unobstructed egress from all parts of th e 
buildings with — ae — looks or fastenings 
installed — es — ex4t — doors — whioh — may 
potentially pr e v e nt immediate e gress from 
the inside of a building or struoture; 

{4) e xits plainly mark e d with dir e ctions to a 

designat e d — terminati ea — at — a plao e — ef 
saf e ty, and exit signs illuminated either 
e xternally or internally. 



Statutory Authority G.S. 131E-79. 

.1804 TRASH CHUTES 

(a) The uso of trash chutes is not r e commend e d, 
but when used th e y must b e install e d in ad e quate 
two hour rated fir e r e sistiv e shafts and provided 
with s uitably labeled fir e doors at e ach access 
op e ning into the ohut e . — In addition, th e acc e ss 

door at e ach floor should b e locat e d in an 

anteroom or vestibule off the corridor so that it is 
readily out off from the r e st of th e floor. — The 
door from oorridor to anteroom or vestibule must 
b e a two hour rat e d door. — Th e top of th e chute 
must e xt e nd full siz e through th e roof to th e 
outdoors sino e , in case of fir e in the chute, it must 
p e rform as a chimn e y. — Th e top of th e ohute 
should b e roof e d with a m e tal hood. — Th e ohute 
should — else — be — provid e d — with — aa — automatic 
sprinkl e r h e ad. — Th e trash ohut e room must hav e 
e nclosur e s of two hour rated construction including 
a two hour rat e d door. 

{b) — For e xisting hospitals, tho us e of all trash 
chutes not install e d in th e abov e mann e r shall b e 
discontinu e d, — oloanod, — scaled — aed — s e cur e d — te 
prevent any possibl e us e . 



Statutory Authority G.S. 131E-79. 

.1805 LINEN CHUTES 

Lin e n — chut es — must — be — installed — m — ad e quat e 
two hour rated fire r e sistiv e shafts and provid e d 
with suitably labeled firo doors at e aoh aoo e ss 
op e ning to th e ohute. — Th e top of th e ohut e must 
e xtend full s iz e through th e roof to th e outdoor s 
sino e , in cas e of fir e in th e ohute, it must p e rform 
as a ohimn e y. Th e top of th e ohut e must b e roofed 
with a m e tal hood. — Th e ohut e must also have 
flushing ring with water valv e aoo e ssibl e in th e 
soil e d linen room, and also hav e an automatic 
sprinkl e r h e ad. — Th e soil e d lin e n room mu s t b e of 
two hour rated oonstruotion and hav e a two hour 
rat e d door. 



Statutory Authority G.S. 131E-79. 

SECTION .1900 - SUPPLEMENTAL 

RULES FOR THE LICENSURE 

OF THE SKILLEDrlNTERMEDIATE: 

DOMICILIARY BEDS IN A HOSPITAL 

.1901 SUPPLEMENTAL RULES 

Wh e n — a — hospital — off e rs — nursing — facility — ef 
domiciliary homo long term car e s e rvic e s, th e 
s e rvio e s — shall — b e inoludod — und e r on e hospital 
lio e ns e as provided in Rule .0201 (o). Th e g e n e ral 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1747 



PROPOSED RULES 



requirements includ e d in this Subchapter shall 
apply when applicable but in addition th e nursing 
facility oar e and domiciliary hom e oar e unit must 
me e t — the — suppl e mental — r e quir e m e nts — ef — this 
S e ction. 

Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 

.1902 DEFINITIONS 

The following definitions shall apply throughout 
this Section, unless t e xt otherwis e cl e arly indicates 
to th e contrary: 

f4) "Accid e nt" — m e ans som e thing occurring 

by chanc e or without int e ntion which has 
caused physical or m e ntal harm to a 
pati e nt, r e sid e nt or employee. 

(3) "Administer" m e ans th e dir e ct application 

of a drug to the body of a pati e nt by 
injection, inhalation, ingestion or oth e r 
m e ans. 

(3) "Administrator" means th e p e rson who 

has authority for and is responsibl e to th e 
gov e rning board for th e ov e rall op e ration 
of a facility. 

{4) "Brain injury long term oar e " is d e fin e d 

as an interdisciplinary, int e nsive 

maint e nanc e program for patients who 
hav e incurr e d brain damage caused by 
e xt e rnal physical trauma and who hav e 

complet e d a primary cours e ef 

rehabilitativ e tr e atm e nt and hav e reach e d 
a point of no gain or progr e ss for mor e 
than throe consecutive months. — S e rvic e s 
at=e — provided — through — a — m e dically 
supervised int e rdisciplinary process and 
are — direct e d — toward — maintaining — the 
individual — at — the — optimal — level — ef- 

physical, cognitiv e and behavioral 

functioning. 

(4) "Capacity" means th e maximum numb e r 

of pati e nt or r e sid e nt b e ds which th e 
facility is lic e ns e d to maintain at any 

giv e n — tim e . T-fek — numb e r — shaH — be 

determin e d as follows: 

{a) Bedrooms shall have minimum square 

footag e of 100 square feet for a single 
b e droom and 80 squar e f e et p e r pati e nt 
ef — r e sid e nt — m — multi b e dd e d — rooms. 
This minimum square footag e shall not 

includ e spac e m toilet rooms, 

washrooms, clos e ts, v e stibul e s. 

corridors, and built in furniture. 

{b) Dining, — r e cr e ation — asd — common us e 

areas available shall total no loos than 
3S — squar e — feet — p e r b e d — fef — skill e d 



m- 



co- 



m- 



m- 






W- 



nursing and intermediate oaro bodo m 
no loos than 30 squar e fe e t per bod # 

domiciliary hom e b e ds. Such ppae 

must — be — contiguous — te — patient as 



r e sident b e drooms. 
"Combination — Facility" m e ans — ea 



hospital with nursing home b e ds whio b- 



licens e d to provid e more than one lew 



ef- — eare — s«eh — as — a — combination — t 



intermediat e car e and/or skilled nuroin 



care and domiciliary hom e car e . 
"Conval e sc e nt Car e " means caro givo 



— ^uuyciictixui — crate lueuiio — um e — gfrv 

for the purpose of assisting the patient - 
resident to regain h e alth or str e ngth. 



'D e partment" m e ans th e North Carolin 
D e partment of Human Reoourooo. 
'Dir e ctor of Nursing" means the nurs 



who has authority and — eife« 

responsibility for all nursing s e rvices an 
nursing car e . 



{49) "Disp e ns e " m e ans — preparing 



-8fi 



packaging a prescription drug or dovic 



in a contain e r and lab e ling th e oontaino 



with information r e quired by state oik 
f e deral law. Filling or refilling dru; 



contain e rs — with — pr e scription — drugs fb 
s ubsequ e nt — use — ey — a — patient — i 



"dispensing". Providing quantities o 

ttfiit dose — pr e scription — drugs — fe 



administration — i 



subs e qu e nt 
"disp e nsing". 

{44) "Drug" mean s substanoes: 

{a) r e cogniz e d in th e official Unit e d State 



Pharmacopoeia, offioial Nationa 



Formulary, or any suppl e m e nt to any o 
them; 



intended for use in th e diagnosis, cure 



mitigation, treatment, or prev e ntion o 
dis e as e in man or other animals; 



int e nd e d to aff e ct the structure or an; 
function of the body of man or oth e 



animals, — ne^ — substanoes — other thai 



food; and 



int e nd e d for us e as a component of an} 
article specified in (a), (b), or (o) o 



this Subparagraph; but does not inolud 



devices or th e ir compon e nts, parts, oi 



aoc e sson e s. 



(4-3) "Duly Lic e ns e d" m e ans holding a ourreff 



and valid license as r e quired under th t 

G e neral Statues of North Carolina. 

{44) "Existing — Faoility" — moans — a — licens e e 



faoility; or a propo se d facility, propooet 
addition to a licens e d faoility or propose* 
remod e led lic e ns e d faoility that will b e 



1748 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



(2D- 



built oooording to plans and sp e cifications 
which — have — been — approv e d — by — the 
departm e nt — through — the — preliminary 
working — drawings — s tag e — prior — te — the 
effectiv e dat e of this Rule. 



(44) "Exit Conferenc e " m e ans the conference 

hold at the end of a surv e y, insp e ction or 
investigation, but prior to finalizing th e 

same, b e tw ee n the d e partm e nt' s 

representativ e s whe — oonduot e d — the 

survey, insp e ction or investigation and 
t-h-e — faoi lity — administration 
ropros e ntativ e (s) . 



(i5) "Inoid e nt" — moans — em — int e ntional — er 

unintentional — aotion, — ooourr e no e — er 
happening which is likely to caus e or 
load to phy s ioal or mental harm to — a 
patient, r e sid e nt or employee. 

(46) "Lioons e d — Pmotioal — Nurs e " — means — a 



nurso who is duly lic e ns e d as a practical 
nurso under G.S. 90, Artiol e 9A. 
(47) "Lic e ns ee " — m e an s — the — person, — firm, 



partnership, association, corporation or 
organization to whom a lio e nso has boon 
i ss u e d. 
(4*) "Medication" means drug as d e fin e d in 



(12) of this Rul e . 



(±9) "N e w — Faoility" — m e ans — a — propos e d 

facility, — a — propos e d — addition — te — aa 
e xi s ting faoility or a propos e d r e mod e l e d 
portion of an e xisting faoility that is 
construct e d — according — te — plans — and 
specifications approved by th e department 
subsequent to the effectiv e date of this 
Rul e . — If d e t e rmin e d by th e d e partm e nt 
that more than one half of an e xisting 
faoility is r e mod e l e d, th e e ntir e e xisting 
faoility shall b e consid e r e d a n e w faoility. 



(30) "Nurs e — Aide" — means — aay — individual 

providing — nursing — er — nursing r e lat e d 
s e rvio e s to pati e nts in a faoility, and is 
not a — lio e nsod — health — prof e ssional, — a 
qualifi e d — di e titian — ef — som e on e — whe 
volunteers — te — provid e — sueh — s e rvio e s 
without pay, and who is list e d in a nurse 
aid e r e gistry approved by the 



Department. 

"Nuroe — Aid e — Train ee " m e an s 



-aa 

individual who has not compl e t e d an 
approv e d nurs e aide training oours e and 

oomp e tenoy — e valuation — ae4 ia 

d e monstrating knowl e dg e , whil e 

p e rforming tasks for whioh they have 
boon found profici e nt by an instructor. 
These tasks shall be perform e d und e r th e 



direct sup e rvision of a regist e r e d nurse. 
The term do e s not apply to volunteers. 

(33) "Nursing Faoility" moans that portion of 

a nursing hom e c e rtified und e r Titl e XIX 
of th e Sooial S e curity Aot (M e dicaid) as 
ia — oompliano e — with — fed e ral — program 

standards for nursing faoilitios. It— is 

oft e n u se d as synonymous with th e t e rm 
"nur s ing — hom e " — whioh — is — the — usual 
pr e r e quisite l e v e l for state lic e nsur e for 
nursing — faoility — (NF) — o e rtifioation — aad 
M e dioar e s kill e d nursing faoility (SNF) 
o e rtifioation. 

(33) "Nurs e in Charg e " m e ans th e nurs e to 

whom duti e s for a sp e cifi e d numb e r of 
patients and staff for a specifi e d p e riod of 
tim e hav e boon delegated, such as for 
Unit A on the 7 3 or 3 11 shift. 

(34) "On Duty" means personn e l who aro 

awak e , — dressed, — responsiv e to — pati e nt 
needs — and — physioally — pr e s e nt — in — the 
faoility p e rforming assign e d duties. 

(3§) "Pati e nt" moans any person admitt e d for 

care to a skilled nursing or interm e diat e 
oar e facility. 

(36) "Physioian" — m e an s — a p e rson — lio e nsed 

under G.S. Chapt e r 90, Article 1 to 
praotio e medicine in North Carolina. 

(37) "Qualifi e d Di e titian" m e ans a p e rson who 

meets the standard s and qualifications 
e stablish e d — by — the — Committ ee — ea 
Prof e ssional R e gistration of th e Am e ri eae 

Dietetio Association inoludod i» 

"Standards of Praotioe" sev e n dollars an d 
tw e nty fiv e c e nts ($7.25) or "Cod e of 
Ethics for the Prof e ssion of Di e t e tics" 
two dollars and fift ee n c e nts ($2.15), 
Am e rican Di e t e tio Association, 216 W. 
Jackson Blvd., Chicago, IL 60606 6995. 

(38) "R e gi s t e r e d Nurs e " m e ans a nurs e who is 

duly lio e ns e d as a r e gist e red nurso under 
G.S. 90, Article 9A. 

(39) "R e sid e nt" m e ans any p e r s on admitted 

for oar e to a domiciliary hom e . 

(30) "Sitt e r" means an individual employ e d to 

provid e — oompanionship — aad — sooial 
intoraotion to a particular r e sid e nt or 
pati e nt, usually on a private duty basis. 

(34-) "Sup e rvisor in Charg e " — m e ans — a — daly 

lio e ns e d — nurs e — te — whom — sup e rvisory 



mh 



duti e s — have — beea — d e l e gat e d — by — the 

Director of Nursing. 

"V e ntilator — d e p e nd e no e " m e ans 



physiological d e p e nd e ncy by a pati e nt on 
th e us e of a v e ntilator for mor e than e ight 



NORTH CAROLINA REGISTER 



February 1, 1995 



1749 



PROPOSED RULES 



hours a day. 
Statutory Authority G.S. 131E-79. 

.1903 INSPECTIONS 

{a) Any hospital with b e ds licens e d by th e 

D e partm e nt und e r S e ction .1900 of those Rules 
may — bo insp e ot e d — by on e or mor e authorized 
r e pr ese ntatives of th e Departm e nt at any tim e - 
G e n e rally, in s p e ctions will bo oonduot e d botwoon 
th e hours of 8 :00 a.m. and 6:00 p.m., Monday 

through Friday. How e v e r, oomplaint 

investigation s — shaH — be oonduot e d — at — th e most 
appropriate tim e for inv e stigating allegations of th e 
oomplaint. 

{b) — At the tim e of insp e ction, any authoriz e d 
r e pr e s e ntative of th e D e partm e nt s hall mak e hi s 
pr e s e nc e known to th e administrator or oth e r 
person in oharg e who shall cooperate with such 
r e pr ese ntativ e and facilitat e th e insp e ction. 

Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 

.1904 PROCEDURE FOR APPEAL 

A hospital with nursing facility or domioiliary 
hom e — beds — may — app e al — aay — d e cision — of th e 
D e partment to deny, r e vok e or alt e r a lio e ns e by 
making suoh an appeal in nooordanc e with G.S. 
Chapter 150B. 



Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 

.1905 ADMISSIONS 

(a) No patient shall b e admitt e d e xc e pt und e r th e 
order s of n duly licens e d physician. 

{b) — Th e facility shall aoquir e prior to or at the 
time — of admis s ion ord e rs — from — the — att e nding 
physician for the imm e diat e car e of the pati e nt or 
resident. 

(e) — Within 4 8 hour s of admission, th e facility 
shaH — aoquire m e dical — information whioh — shall 
includ e — curr e nt — m e dioal — findings, — diagnosis, 
r e habilitation pot e ntial, a summary of th e hospital 
s tay if th e pati e nt is b e ing transf e rr e d from a 
hospital, and ord e rs for th e ongoing oar e of th e 
pati e nt. 

{d) — If a patient i s admitt e d from somewhere 
oth e r than a hospital, a physical e xamination shall 
be — p e rforme d — e ith e r — within — § — days — prior — te 
admission or within 4 8 hours following admission. 

{e) Hospitals — off e ring — nursing — facility — ef 

domioiliary hom e oar e as a n e w s e rvic e must 
pr e par e a plan of admission whioh, at a minimum, 
assur e s availability — of staff time and plans for 
individual patient ass e ssm e nts, initiation of h e alth 



oar e or nursing cor e plans, and impl e m e ntation - 



physician and nursing treatm e nt plans. — This pk 
must b e available for insp e ction during tho ini t i 



lic e nsur e survey prior to isouano e of a lioonoc - 
{£) — Only p e rsons who are 1 8 y e ars of ago 



old e r shall b e admitted to domioiliary homo hot 



in a facility. 

Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 



.1906 POLICD2S AND PROCEDURES 



Th e gov e rning board shall assur e written poliok 
and — proc e dur e s — whioh — ate — available — te- 



-m 



impl e m e nt e d — by — staff. Those — polioios — as 



proc e dur e s shall oov e r at least tho following area 






admi ss ion s ; 



dietary; 

discharges — with — phy s ician — ord e rs an 



(4)- 



pati e nts — er — residents — l e aving — again! 

physician advioo; 

gratuiti es — and solicitation whioh at 



minimum s hall provid e that no ownoi 



op e rator, ag e nt or e mployee of a faoilit 
nor any — m e mb e r of his — family oho 



accept a gratuity directly or indirootl 



from on patient or r e sid e nt in th e faoilit 
or solicit for any typ e of contribution; 



{5) hous e k ee ping; 

{6) infection control whioh must inolud e , b\i 



shall not b e limit e d to, r e quir e ments fo 
st e ril e , as e ptio and isolation t e chnique 
and — oommunioabl e — dis e as e — soreenin 



including, — at — a — minimum, — onnut 
tub e roulosis scr ee ning for all staff ani 



inpati e nts of tho facility; 



{?) maint e nanc e of pati e nt m e dioal or h e altl 

oar e r e cords inoluding oharging or r e oon 



keeping; 

(8) ori e ntation of all facility p e rsonn e l; 

{9) patient or r e sid e nt oar e plans, tr e atm e n 



and oth e r h e alth oar e or nursing oar e 



inoluding but not limit e d to all polioia 



m- 



and — proo e dur e s — r e quir e d — by — nrief 
contain e d in this Subchapt e r; 
patients' or r e sidents' rights; 



{44) physical — e valuation — fer- — r e sid e nts — a« 

pati e nts at l e ast annually; 



{44) physioian servic e s and utilization pf th' 

individual's privat e physician; 

{44) proour e mont of supplies and equipment tt 

m ee t individual patient car e ne e ds; 

{44) protection of pati e nts from abuse a n. 

nogleot; 

{44) rang e of services provid e d; 



{46) r e cording and r e porting to tho departm e nt 



1750 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



of aooid e nto or incidents occurring to 
pationto in any part of th e facility and 
maintenanc e of suoh reports or records; 
(i7) rehabilitation services; 



{43} releas e of medioal r e cord informatio n-; 



[l b ) releas e 01 muuium l e uoiu imuimutiuu, 

(i9) sorooning and r e porting communicabl e 

disease to th e local health d e partm e nt; 



afro 

{20) transf e rs. 



'tatutory Authority G.S. 131E-79. 
1907 GENERAL 



The governing board shall assure that policies 
nd procedur e s are availabl e and impl e m e nt e d for 



ssossing each patient's or r e sid e nt's h e alth oar e 
oodo and planning for m ee ting id e ntifi e d h e alth 



are ne e ds. Th e r e shall b e a syst e m for e valuating 
io eff e ctiveness of th e ass e ssm e nt, planning and 



nplomontntion (d e liv e ry of car e processes) for 
aoh patient or r e sid e nt. 



tatutory Authority G.S. 131E-79. 

1908 FREQUENCY: METHOD 

AND CONTENT OF ASSESSMENT: 
PLANNING 



Each pati e nt's and r e sid e nt's condition must be 
ssooood on a r e gular, p e riodic basis, at l e ast 



uartorly, with appropriate notation and updating 
f th e h e alth oar e plan. — H e alth oare planning for 



aoh patient and resid e nt shall b e an on going 
roo e s s and must includ e , but shall not b e limited 



), the following: 



(i) date — which — ie — syst e matically — and 

continuously coll e ct e d about his or her 
health status; the data shall be reoordod 
so as to bo accessible and communicat e d 
to all s taff involv e d in th e pati e nt's or 
resid e nt's car e ; 

n ee ds id e ntifi e d and 



m- 



curr e nt probl e ms or 
prioritized from a oompl e t e d ass e ssment 
rel e vant to — th e pati e nt's — or resident's 
r e sponse to aging, illn e s s and g e n e ral 
health statu s ; and 



(2) a curr e nt plan — of oare d e v e lop e d — ifi 

oonjunotion with the patient or resid e nt or 
l e gal guardian that inoludes measurabl e 
tim e relat e d goals and approaoh e s, or 
measures — te — be — employed — by — various 
disciplin e s — m — ord e r — te — achi e v e — tbe 
identified goals. 

'tatutory Authority G.S. 131E-79. 



.1909 IMPLEMENTATION OF 
HEALTH PLAN 

All parts of the plan of oar e shall bo assigned to 
speoifio disciplin e s or staff as indioated in th e plan 
of care to assur e that h e alth oar e and rehabilitative 
s e rvices ar e p e rform e d daily and docum e nted for 
thos e pati e nts and r e sid e nts who r e quire such 
s e rvic e s. 



Statutory Authority G.S. 131E-79. 

.1910 NURSING/HEALTH CARE 
ADMINISTRATION AND 
SUPERVISION 

(a) — A lic e nsed faoility shall have a director of 
nursing s e rvic e who shall bo responsible for the 
ov e rall organization and manag e ment of all nursing 
s e rvic e s and shall b e ourr e ntly lic e ns e d to praotio e 
as a r e gistered nurse by th e North Carolina Board 
of Nursing in accordanc e with G.S. 90, Article 
9A, 

{b) — Th e Dir e ctor of Nursing shall not serve as 
admini s trator or assistant administrator. 

(e) — A licensed faoility with nursing faoiliti e s 
shall provid e a full tim e dir e ctor of nursing on 
duty at least e ight hours per day, fiv e days a w e ek. 
A r e gister e d nurs e shall r e li e v e th e Dir e ctor of 
Nureing — (b e in — oharg e of nursing) — during — the 
Dir e ctor's absence. 

{4) — A lioensed faoility shall employ and assign 
regist e r e d nurs e s, lic e ns e d practical nurses, nurse 
aid e s — and — nurs e — aide — train ee s — fef — duti e s — in 
aooordano e with G.S. 90, Articl e 9A. 

(e) — Th e Director of Nursing shall oauso the 
following to b e accomplish e d: 

fl-) e stablishm e nt — and — impl e mentation — ef 

nursing polioies and proooduros which 

s hall includ e , but shall not b e limit e d to 

th e following: 

(A) — ass e ssm e nt — ef- — and — planning — fef 

pati e nts' nursing oar e or h e alth care 

n ee ds, and impl e m e ntation of nursing 

or health oare plans; 

(B) — daily — charting — ef- — any — unusual 

oocurr e no e o or aout e episod e s r e lat e d 

to pati e nt oar e , and progress not e s 

writt e n — monthly — r e porting — eaeb 

patient's p e rformanc e in accordanc e 

with id e ntifi e d goals and objectives 

and e ach pati e nt' s progr e s s toward 

r e habilitativ e nursing goals; 

(G) — assuranc e of th e delivery of nursing 

s e rvices re aooordano e with 

physicians' ord e rs, nursing oar e piano 
and — tbe — facility' s — polioies — and 



K21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1751 



PROPOSED RULES 



prooedure o ; 
(&} — notification of e morgonoy physioians 

or on oall physicians; 
(E) — inf e ction control te pr e v e nt 

cross infection — among — pati e nts — aad 

SteSr 

reporting of d e aths; 



(6) — emerg e ncy reporting of fir e , pati e nt 
and staff accid e nts or incid e nts, or 
other em e rg e ncy situations; 

(H) — us e of protective doviocc or r e straints 
to assure that e aoh patient or resident 
is — restrain e d — m — aooordano e — with 
phy s ician — ord e rs — and — the — facility's 
polici e s, — and — that — the — restrain e d 
pati e nt or resid e nt — is — appropriately 
evaluated and released at a minimum 
of every two hours; 

{£) sp e cial skin care and d e cubiti car e ; 

{J} bow e l and bladd e r training; 

{K) — maint e nanc e of prop e r body alignm e n t 
and r e storativ e nursing oar e ; 

{t) — sup e rvision of and assisting pati e nts 
with feeding; 

(M) — intak e — asd — output obs e rvation and 
r e porting — for thos e pati e nts — whose 
condition warrants monitoring of th e ir 
fluid balanc e . This will includ e thos e 
patients on intrav e nous fluids or tub e 
f ee dings, — and patients — with — kidney 
failur e and temp e ratur e s e levat e d to 
102 degrees Fahrenheit or abov e ; 
cath e t e r car e ; and 



<N> 

(O) — proc e dur e s us e d in oaring for pati e nts 
in th e facility; 

f2-) developm e nt of writt e n job descriptions 

for nursing personnel; 

(3) p e riodic — ass e ssm e nt — ef- — the — nursing 

id e ntification ef 



Strtrt 

with 



department 
p e rsonnel r e quir e m e nts as th e y relate to 
pati e nt care needs and r e porting sam e 
to the administrator; 

{4) a plann e d ori e ntation and continuing 

inservio e e ducation program for nursing 
employees and documentation of staff 
attendanc e and subject matt e r cov e r e d 
during ins e rvic e e duoation programs; 



to assur e that appropriate supplies on 



e quipm e nt ar e availabl e to nursing ste 



as d e termin e d by individual patient oat 



needs. 



Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 

.1911 VACANT DIRECTOR OF 
NURSING POSITION 

(a) The — administrator — shaH — notify — ft, 



Department within 72 hours wh e n th e director - 



nursing position b e comes vacant and shall provid 
th e name and lic e ns e number of the individual wh 



acting director or the replacement for tb 



dir e ctor of nursing. 
{©) — A facility shall not operate without cither 



dir e ctor of nursing or acting dir e ctor or nuroing. 
(o) The administrator shall e mploy a dirootor o 



nursing within 30 days after a position become 
vacant. A vacancy which exceeds 30 days shall b 



reviewed by the D e partment for aotion r e lative h 



lic e nsur e status of th e facility. 
Statutory Authority G.S. 131E-79. 



.1912 NURSE STAFFING REQUIREMENTS 



(a) — A licens e d facility shall provid e lio e nsoe 
nursing personn e l — suffici e nt to — accomplish th( 



following: 

f+) patient n ee ds ass e ssm e nt, 

{2} pati e nt oar e planning, and 



f3) supervisory — functions — ia — accordance 



with th e l e v e l of pati e nt or r e sid e nt car s 

advertis e d or off e r e d by th e faoility. 

The — faoility — ake — shaH — provid e — oth e r nursing 



personn e l suffici e nt to assur e that at least aotiviti e c 



of daily — living, — personal — grooming, — restorativ e 
nursing actions and oth e r health oare needs a; 



id e ntifi e d in each pati e nt's or resid e nt's plan o: 



car e are met. 



(b) A lic e ns e d multi stori e d facility (ono having 
mor e than on e story) shall provid e at least on e 



p e rson on duty on eaoh patient oare floor at all 



times. 



fe) Daily dir e ct pati e nt oar e nursing staff. 

licens e d and unlic e ns e d, shall e qual or e xceed 2.1 



nursing hours p e r pati e nt. — (This is sometime s 



{§) provision — ef- — appropriate — r e ference referred to as nursing hours p e r patient day or 



mat e rial s for the nursing departm e nt, 
which — includ e s — a — Physician's — D e sk 
R e f e r e no e — ef — comparabl e — drug 

r e f e r e nce, policy and proc e dur e 

manual, and m e dioal dictionary for e aoh 
nursing station; and 
{&) e stablishm e nt of op e rational proo e dur e o 



NHPPD or NH/PD.) 



{+) Inclusive — m — these — figures — is — the 

r e quir e ment that at least ono lioono e d 



nurse is on duty for dir e ct patient oare 
at all tim e ; and 



{3) Nursing oar e shall includ e tho sorvioes 

of a r e gist e r e d nurs e for at least eight 



1752 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



oono e outiv e hours a day, oovon dayo a 
w ee k. — This oovomge oan b e spr e ad 
ovor mor e than ono shift if suoh a need 
exists . — Th e Dir e ctor of Nursing may 
bo count e d as mooting the requir e m e nts 
for both the Director of Nursing and 
pati e nt and r e sid e nt oar e staffing for 
faciliti e s of a total c e n s u s of 60 beds or 

(d) — Nursing support personnel inoluding ward 
orlcs, secretari e s, nurs e e ducators and p e rsons in 



imarily administrative management positions and 



>t aotively involved in direct patient car e shall 



>t bo count e d toward compliance with minimum 



dly requirements for dir e ct car e staffing. 

{e) — All exc e ptions to m ee ting minimum staffing 



quiromonts shall b e r e port e d to th e D e partm e nt 
the e nd of e aoh — month. Staffing waiv e rs 



untod by tho f e d e ral gov e rnm e nt for M e dicar e 



id Medioaid c e rtifi e d b e ds s hall b e acc e pt e d for 



jonsur e purpos e s. 

(f) The ratio of mal e to f e mal e nurs e aid es will 



i determin e d by — the — needs — of tho patients, 



irtioularly th e numb e rs of mal e pati e nts r e quiring 
i siotanoe with p e rsonal oar e . 



uthority 
>)(4)(C). 



ay also — s e rv e as — sup e rvisor in charg e of th e 



jmioiliary hom e b e ds. 



nilding, ther e must b e a p e rson on duty in th e 



G.S. 131E-79; 42 U.S.C. 1396 r 



915 DOMICILIARY HOME PERSONNEL 
REQUIREMENTS 

(a) Th e administrator shall d e signat e a p e rson to 



i in oharg e of th e domioiliary home resid e nts at 
1 times. — Th e nurs e in oharg e of nursing s e rvic e s 



{b) — If domioiliary hom e b e ds ar e locat e d in a 



iparate building or a s e parate level of tho 



sam e 



omioiliary homo ar e as at all tim e s. 

(e) — A lic e ns e d facility shall provid e suffici e nt 



xuT to assur e that activiti e s — of daily living, 



Toonal grooming, and assistance with e ating ar e 



rovid e d — te eaea — r e sident. 



M e dication 



iministration ao — indioat e d — by — eaeh — r e sid e nt's 
mdition or physician's ord e rs shall b e carri e d out 



j id e ntified in oaoh r e sid e nt's plan of oar e . 

{d) — Domioiliary homo faciliti es (Hom e for th e 



g e d bods) lio e nsod as a part of a combination 
oility shall oomply with th e staffing r e quir e m e nts 



f 10 NCAC 42D .1 4 07 as adopted by th e Social 



e rvioos Commission for freestanding domioiliary 



omos. 



tatutory Authority G.S. 131E-79; 42 U.S.C. 1396 



r(a). 



.1916 



REHABILITATIVE NURSING 
AND DECUBITUS CARE 



Eaoh pati e nt or resident shall b e givon oar e to 
prevent contractures, — deformiti es^ — and dooubiti, 
inoluding but not limit e d to: 

{!) changing — positions — ef- — b e dfast — and 

ohairfast patients or r e sid e nts ev e ry two 

hours and — administering s impl e 

pr e ventiv e car e . — Docum e ntation of suoh 
car e and outcom e must b e inoludod in 
routine summaries or progr e ss not e s; 

{3) maintaining proper alignm e nt and joint 

mov e m e nt to pr e v e nt contractur e s and 
deformities, which must b e docum e nt e d 
in routin e summaries or progr e ss not e s; 

@) impl e m e nting — ae — individualiz e d — bow e l 

and bladd e r training program except for 
pati e nts or r e sid e nts whos e r e cords are 
document e d — that — s«eh — training — is — net 

e ff e ctive. A — monthly — summary — fef 

pati e nts — and — quart e rly — s ummari e s — fef 
domioiliary — r e sid e nts — shaH — be — written 
r e lativ e to e aoh pati e nt's — or re s ident' s 
p e rformanc e in th e bow e l and bladd e r 
training program; and 

(4) suoh oth e r se rvic e s as necessary to meet 

th e ne e ds of the pati e nt. 



Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 

.1917 MEDICATION ADMINISTRATION 

{a) — A lic e ns e d facility shall hav e policies and 
proc e dur e s — gov e rning — the — administration — ef 
m e dioations — which — s hall — be — e nforo e d — and 
implemented by administration and staff. — Policies 
and proc e dur es shall include, but shall not be 
limited to: 

^ automatic stop ord e rs for treatm e nt and 

drugs; 

(3) accountability of controll e d substanc e s 

as — d e fin e d — by — the — North — Carolina 
Controlled Substanoos Aot, G.S. 90, 
Artiol e 5; 

0) dispensing and administering behavior 

modifying drugs, — suoh as hypnotics, 
s e dativ e s, tranquiliz e rs, antid e pr e ssants 
and — oth e r — psychoth e rap e utic — agents; 

insulin; intrav e nous fluids and 

m e dioation s ; cardiovascular r e gulating 

drugs; and antibiotic s . 

(b) All m e dioation s or drugs and tr e atm e nts shall 

b e admini s t e r e d and discontinued in accordance 

with sign e d physioian's orders which ar e r e cord e d 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1753 



PROPOSED RULES 



in the pati e nt's or resid e nt's m e dioal record. 

£4-) Only — physicians, — register e d — nurs e s, 

lioonsod practioal nurses or physician 
assistants, — if in accordanc e with th e 
assistant's — approved — practic e , — shall 
administ e r m e dications. 

f3-) Te e nsure accountability, any 

m e dication shall be administer e d by the 
same licensed personnel who pr e par e d 
the dos e for administration. — This Rul e 
does not apply to th e disp e nsing of 
medications from a pharmacy utilizing 
a unit of us e drug deliv e ry syst e m. 
Medications — shall — be — administ e r e d 
within a half hour prior to or half hour 

after the pr e scrib e d ti»e fef 

administration — unless — preclud e d — by 
emorgenoy situations. 

(4) The p e rson administ e ring m e diations 

shall identify e ach pati e nt or resident in 
accordanc e with th e facility's policies 
and proc e dures prior to administering 
any medication. 



m- 



w- 



physioian within fiv e days of issuance. 
Statutory Authority G.S. 131E-79. 

.1918 TRAINING 

{a) A licensed fnoility shall provide for -a 



patient — or resident core e mployees — a plann e 
orientation — and — continuing — e duoation — pro gnu 



e mphasizing pati e nt or resident assessment aa 



planning, — activities — ef- — daily — living, — p e rson 



grooming, — r e habilitative — nursing — ef — restomth 



car e , oth e r pati e nt or resident car e polioios ob 



proc e dures, pati e nts' rights, and staff p e rformaiK 



e xp e ctations. Attendanc e — and — subj e ct — me&t 

cov e r e d shall be docum e nt e d for each session an 



availabl e for lic e nsur e insp e ctions. 
{¥) — The administrator shall assur e that cac 



e mploy ee is ori e nt e d within th e first week c 
employm e nt to th e facility's philosophy and goal i 



(o) Each e mploy ee shall hav e sp e cific on the jo 



training as n e c e ssary for th e e mployee to propcrl 
p e rform his individual job assignment. 
(4) — Unless oth e rwise prohibited, a nurse aid 



(S) M e dioation administered to a pati e nt or trainee may b e e mploy e d to p e rform th e duties 



resident — shall — be — r e cord e d — is — the 
pati e nt's — ef — resid e nt's — m e dication 
administration r e cord imm e diately aft e r 
administration in accordanc e with th e 
facility's policies and procedures. 

{6} Omission of m e dication and th e r e ason 

for th e omission shall b e indioated in 
the — pati e nt's — ef — r e sident's — medical 
r e cord. 

{7} The person administ e ring medications 

which — are — ord e r e d — te — be — giv e n — as 
n e ed e d (PRN) shall justify the need for 
the sam e in the pati e nt's or r e sid e nt's 
m e dical r e cord. 



a nurs e aide for a period of time not to oxooo 
four months. — During this p e riod of tim e the nun 



aid e traine e shall b e permitt e d to p e rform onl 
thos e — tasks — fef — which — minimum — acceptabl 



-SB- 



competence has b e en d e monstrated 

document e d on a skills oh e ck off record. — fe 



applicants — for nurs e aid e — positions — who woi 



formerly qualifi e d nurs e aides but hav e not bee 



gainfully employ e d as such for a period of 2 
oons e outiv e months or mor e shall b e e mploy e 



only as nurs e aid e train e es and must r e qualify a 
nurs e — aides — within — few — months — of hire b' 



successfully — passing — aa — approv e d — competent 
evaluation. Any individual, nursing home, o 



M e di 



lication administration r e cords shall 

provid e id e ntification of th e drug and 

str e ngth — ef- — drug. — quantity — ef- — drag 

administ e r e d, — name — of administ e ring 

employee, title of employ e e and tim e o f 

administration. 

{e) — Self admini s tration of medications shall b e 

p e rmitted only if prescrib e d by a physician and 

dir e ctions ar e print e d on th e contain e r. 

(d) The — administration of one pati e nt's — ef 

r e sident's — medications — te — another — pati e nt — ef 
r e sident is prohibit e d e xc e pt in th e cas e of an 
e m e rg e ncy. — In th e e v e nt of such an emerg e ncy, 
st e ps shall bo taken to assur e that th e borrow e d 
m e dioations shall b e r e plac e d promptly and so 
docum e nt e d. 
(e) — Verbal orders shall bo count e rsigned by a 



e ducation facility may off e r D e partment approv e 
vocational eduoation for nursing homo nurse aid e s 



An accurat e r e cord of nurs e aid e qualification 
shall b e maintain e d for e ach nurse aide used by 



facility — asd — sbaH — be — r e tain e d — m — the gonert 
personnel files of the facility. 



{e) — Th e curriculum cont e nt r e quired for nurs 
aide — e duoation — programs — shall — be — subject t 



approval by th e Division of Facility' Services am 
shall includ e , as a minimum, basic nursing skill 

-as 



personal — eefe — s kill s , — cognitive, — behavioral 



social care, basio restorativ e s e rvices, and patients 
rights. Successful course complotion shall b 



d e t e rmin e d by passing a competency ovaluatio 
testr — Th e minimum number of cours e hours ohal 



b e 75 of which at least 20 hours shall bo olaosroon 



and at least — 4 hours of supervised praotio a 



1754 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



ompotenoy evaluation ohall b e oonduotod in e aoh 
the following aroao: 



PROPOSED RULES 



porionoe. — Tho initial ori e ntation to th e faoility 
all bo oxoluoivo of th e 75 hour training program. 



{i) Observation and documentation, 

{3) Baoio nursing skills, 

{£) Personal oor e skill s , 

{4) Mental health and sooial s e rvic e n ee ds, 

{§) Basic restorativ e s e rvic e s, 

(6) Residents' Rights. 



O Suooossful cours e compl e tion and — skiH 

unpot e noy shall b e det e rmined by comp e tency 



valuation approv e d by the D e partm e nt. 



ommonoing July 1, 19 8 9, nurs e aid e s who had 



rmorly boon fully qualifi e d und e r nurs e aide 
aining — requirem e nts — may — ro establish — their 



jalifioationo by suoo e ssfully passing a comp e tency 
valuation t es t. 



te — tiffle — ef- — admission — with — the — following 
iformation — being — plao e d — ia — the — patient' s — ef 



> aid e nt's m e dioal or h e alth car e r e cord: 



uthority G.S. 131E-79; 42 U.S.C. 1396 r (b)(5). 

919 DENTAL CARE 

(a) — A dental examination s hall b e p e rform e d at 



ft) type — of di e t — whioh — the — pati e nt — ef 

resident — eae — best — manag e — ( s uoh — as- 

normal, soft or pur ee d); 
f3) tho presence — of infection — of gums, 

t ee th, or jaws; 
f3) bri e f d e scription s — of any — r e movabl e 

d e ntal applianc e s and a stat e m e nt of 

th e ir condition; and 



W- 



indications for d e ntal tr e atm e nt at th e 
tim e of admission. 



(b) Nam e s of d e ntists who hav e agr ee d to r e nd e r 
m e rg e noy d e ntal oar e shall be maintain e d at e aoh 



uroing station and at th e sup e rvisor's station in a 



omioiliary hom e . 



(o) Staff of tho faoility s hall e n s ur e that: 

ft) noooGsary daily d e ntal oar e is provided; 

f2) eaeh — pati e nt — ef — r e sid e nt — poss e ss e s 

appropriate toothbrush e s aad is 

e ncourag e d — aad-, — wh e n — n e c e ssary, 
assist e d in their use; and 

f3) eaeh — patient — ef — r es id e nt — having — a 

r e movabl e — d e ntur e — is — furnish e d — a 
r e o e ptaol e in whioh to immerse tho 
d e nture in wat e r ov e rnight. 

tatutory Authority G.S. 131E-79. 

1920 AVAILABILITY OF 

PHARMACEUTICAL SERVICES 



<&- 



-A — licensed — faoility — shall — provide 



pharmaceutical s e rvic e s und e r th e sup e rvision of a 
pharmacist currently lic e ns e d to praotio e pharmaoy 
in North Carolina. 

{b) — A faoility shall b e r e sponsibl e for obtaining 
drugs, th e rap e utic nutrients and r e lat e d produoto 
pr e scrib e d or ordered by a physioian for pntionts 
or r e sid e nts in tho faoility. 

(e) — Sorvioos shall include docum e nt e d on site 
pharmaoeutioal r e vi e ws accompli s h e d at l e ast every 
3 1 oal e ndar days for all pati e nts and r e sid e nts. 

Statutory Authority G.S. 131E-79. 

.1921 DINING FACILITIES 

Pati e nts, including wheolohoir patients, shall bo 
encouraged to oat at th e tabl e s in tho dining area 
aad — shaH — be — assist e d — wh e n — necessary — by 

non di e tary — staff. An overb e d table — shall — be 

provid e d for pati e nts who eat in b e d. — A sturdy 
tray stand shall b e provided for those patients who 
e at out of b e d but ar e unabl e to go to the dining 
ar e a. — An ov e rb e d tabl e whioh can b e low e r e d to 
chair height may substitute for tho tray stand. 



Statutory Authority G.S. 131E-79. 

.1922 ACTIVITIES AND RECREATION 

(a) The — administrator — shaH — d e signat e — aa 

activities and r e or e ation dir e ctor to b e in charge of 
activiti e s — aed — r e oreation — fef — aH — pati e nts — aad 
r e sid e nts. — Th e activiti e s and r e or e ation dir e ctor 
shall hav e training and e xp e ri e nc e in dir e cting 
recreational and group activities. — Tho designated 
activiti e s and r e oreation dir e ctor shall b e under th e 
sup e rvi s ion of th e — administrator and — shall — be 
qualifi e d to m ee t th e needs of the pati e nts and 
r e sid e nts. — A qualifi e d individual shall b e anyone 
e ligibl e for a N.C. — lic e ns e as an occupational 
th e rapist or assistant th e rapist und e r G.S. 90 270; 
anyon e — e ligibl e — fef — NrG — certification — as — a 
r e oreation th e rapist or assistant th e rapist und e r 
G.S. 90C 9; anyon e with a baooalaur e at e d e gree 
aad — eae — yeaf — e xp e ri e nc e ; — anyon e — wae — has 
oompl e t e d an approv e d 36 hour or long e r cours e 
in activiti e s program manag e ment; or anyon e not 
oth e rwis e qualified but r e c e iving at least four 
hours consultation p e r month from on e who is 
qualifi e d. 

{b) The — faoility — saaH — maintain — aed — make 

availabl e a listing of looal r e sourc e s for activiti e s 
and reoreation to bo utilized in m e eting tho needs 
and int e r e sts of all pati e nts and r e sid e nts. 

fe) — R e storation to s e lf oar e and r e sumption of 
normal activity shall bo ono of tho main goals of 



h-21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1755 



PROPOSED RULES 



th e r e or e ation or activity program. — Th e ooop e of 
the activity program shall inolud e : 

ft) social activiti e s involving individual and 

group participation which are design e d 

to promote group relationships; 
(i) r e cr e ational activiti e s, both indoor and 

outdoor; 
(3-) opportunity to participat e in activities 

outsid e th e facility; 
(4) religious programs, inoluding th e right 

of eaoh pati e nt and r e sident to attend 

the churoh or r e ligious program of his 

ohoio e ; 

cr e ative and e xpr e ssiv e activities; 

educational activities; and 






e x e rcis e . 



{4) — Th e facility shall have writt e n polici e s and 
proc e dur es which ar e availabl e and implement e d 
by staff that: 

fl-) attempt to prev e nt the furth e r m e ntal or 

physioal d e t e rioration for thos e pati e nts 
or r e sid e nts who oannot realistically 
resume normal activiti e s; 

{3) assur e opportuniti e s fer pati e nt 

involvement, both individual and group, 
in both planning and implementing th e 



activity program; 



{3} provid e — pati e nts — er — residents — the 

opportunity for choice among a vari e ty 
of activiti e s; and 

{A) e ncourag e participation by each patient 

or resid e nt in social and r e creational 

activiti e s according to individual need 

and abiliti e s — and d e sir e s — unl e ss the 

patient' s or r e sident's r e cord contain s 

docum e ntation — that h e — is — unabl e to 

participat e . 

(e) — Each pati e nt's or r e sid e nt's activity plan 

shall b e a part of his ov e rall plan of oar e and shall 

contain docum e ntation of p e riodic ass e ssments of 

th e individual's activity needs and int e rests. — A 

r e cord of activities and individuals participating 

shall be maintained in th e facility. 

{$) — A lic e ns e d facility shall display a monthly 
activiti e s cal e ndar which inolud e s vari e ty to appeal 
to diff e r e nt int e r e st groups in th e nursing car e and 
domiciliary hom e servic e s, 
(g) A licens e d facility shall provid e : 



m- 



Space for r e cr e ational and div e rsional 
activities. In hospitals off e ring n e w 



nursm 



g- 



iom e s ervice s . 



s pac e 



s hall b e 



provid e d — s e parat e ly — from — the — main 

living and dining areas; however, these 

areas may also b e us e d for social activities. 

{2j Designated indoor and outdoor activity 



areas for independ e nt and group ne u d 



of pati e nts and resid e nts, and whie 






(A) — accessible to wheelchair and ambiA 



tory patients; and 
(B) — ef — suffici e nt — size — te — aoeommodat 



necessary e quipm e nt and p e rmit unofe 
struot e d mov e m e nt of whe e lchair oa t 



ambulatory — pati e nts — er — p e molin e 



r e spon s ibl e for instruction and supa 



vision. 



(3) Ad e quat e spao e to store equipment as 



supplies — without — blocking — e xists o 



oth e rwise threatening th e health qb 



saf e ty of patients and r e sidents. 



{¥) Ther e shall bo equipment and oupplio 

suffici e nt to carry out plann e d programs for bo t 



individual and group activities. 

Authority G.S. 131E-79; 42 U.S.C. 1396 r (a). 



.1923 SOCIAL SERVICES 



(a) Th e administrator shall d e signat e an employ 
ee to b e r e sponsibl e for th e provision of sooi a 



s e rvic e s. This person shall b e known as the soeia 



s e rvic e s dir e ctor. — Subs e qu e nt to th e e ff e ctive dat( 



of th e rul e s contain e d in this Subchapt e r any nowrj 
designat e d p e rson must b e a graduate of a foui 



year coll e g e or univ e rsity with on e y e ar's oxpori 
e nc e in th e h e alth car e or long t e rm car e field o: 



have an equivalent combination of e ducation one 
e xperienc e . — An e quival e nt combination of e duoa 



tion and e xp e ri e nc e m e ans th e numb e r of y e ar s o 
e duoation leading to a baccalaur e at e or associat e 



degr ee plus th e number of y e ars of long t e rn 



nursing facility e xperi e nc e e qual to fiv e years; 
eligible for certification as a social worker pursu 
ant to G.S. 90B 7. — Th e social services directo: 



shall hav e authority to oarry out provisions — ee& 
tain e d in Rule .1923(b) of this Section. 
(b) Each pati e nt's or r e sid e nt's plan of oare shal 



contain a writt e n plan for me e ting his individual 
social needs and involving his active participation, 



th e plan shall provid e for: 



w- 



n e ed e d — assistanc e — m — meeting — fee 
pati e nt's or r e sid e nt's physical, oooial 



a-ad emotional n e eds through 

consultation with th e patient or resident 



er — h+s — l e gal — guardian, — and — relativ e 
physician or oth e rs; 



{2-) assisting — the — patient — er — resident in 

adjusting — te — his — environm e nt, — fef 



referral to other supporting resource s- 
fef — prot e ctive — sorvio e s, — fer — finanoia J 



s e rvic e s and for assistance at the time 



1756 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21\ 



PROPOSED RULES 



of discharg e or transf e r into a n e w 
onvironmo ntt 

0) the utilization of oooowork e ro employ e d 

by th e oounry d e partm e nt of social 
servic e s in th e oaao of r e cipi e nts of 
public assistanc e and for th e utilization 
of appropriat e p e rsons with e xp e ri e no e 
and training in th e g e n e ral area of 
sooial work in the oas e of thos e not on 
public assistanc e . 



(o) Discharg e planning shall b e in k ee ping with 
tea — pati e nt' s — and — r e sid e nt's — discharg e — needs, 
hose arc as follows: 



{±} The administrator shall assur e that a 

m e dioal order for discharg e inoluding 
any — s p e cial — instructions — for m ee ting 
r e habilitation pot e ntial is obtain e d from 
all patients or r es id e nts e xo e pt wh e n a 
pati e nt — or resid e nt — l e av e s — against a 
physician's ord e r or advic e ; and 

(2) The — sooial — servic e s — dir e ctor — shaH 

coordinate discharg e instructions — and 
assure that pati e nts and r e sid e nts and 

th e ir — famili e s afe — in s truct e d in 

accordance with discharg e orders. 

tatutory Authority G.S. 131E-79. 



1924 RESTRAINTS 

(a) Pati e nts and residents shall b e restrained only 



y phy s ician orders. 

(b) The nurs e in oharg e shall be r e sponsible for 



ooum e nting same in the pati e nt's or r e sid e nt's 



taking the d e cision r e lativ e to n e c e ssity for, type 
od duration of r e straint in e m e rg e ncy situations 



s quiring r e straints whil e contacting th e physioian. 
ae — nurs e — atee — shaH — be — r e sponsible — fef 



{e) — Th e typ e of restraint us e d and th e tim e of 
pplioation and r e moval shall bo recorded by a 



o e naed nurs e in th e pati e nt's or resid e nt's r e cord. 
tatutory Authority G.S. 131E-79. 
1925 REQUIRED SPACES 



Th e total space r e quir e m e nts shall bo those sot 
Jrth in Rule .1902(4) of this S e ction. — Physioal 



l e rapy and occupational th e rapy spao e shall not bo 
idud e d in th e se totals. 



tatutory Authority G.S. 131E-79. 

1926 NURSING HOME PATIENT OR 
RESIDENT RIGHTS 

(a) — Writt e n polioi e s and proc e dures shall bo 



d e v e lop e d and e nforo e d to impl e m e nt requirements 
in G.S. 13 IE 1 15 e t soq. (Nursing Home Patients' 
Bill of Rights) conc e rning th e rights of patients 
and r e sid e nts. — Th e administrator shall mak e th e s e 
polioi e s and procedures known to the staff, patients 
and — r e sid e nts, — and — families — ef- — pati e nts — and 
r e sid e nts and shall e nsur e th e ir availability to the 
public by plaoing th e m in a oonspiouous place. 

(b) — Any violation of pati e nt rights oontnined in 

St* 131E 117 — shaH be — d e t e rmin e d — by 

r e pr e sentativ e s of th e D e partm e nt by investigation 
or survey. 

(e) — If a lic e ns e d facility is found to b e in 
violation of any of th e rights contain e d in G.S. 
131E 117, th e D e partm e nt shall impos e p e nalties 
for e ach violation as provided by G.S. 13 IE 129. 

(d) When the D e partm e nt has boon notified that 
corrective aotion has boon tak e n for e ach violation, 
v e rification — ef- — sam e — shaH — be — mad e — by — a 
r e pr e s e ntativ e of th e D e partm e nt. 

( e ) Th e D e partm e nt shall oalculatc a total of all 
fin e s l e vi e d against a faoility based on th e numb e r 
of violations and th e number of days and patients 
or r e sid e nts involv e d in e ach violation. 

(f) Th e D e partm e nt shall mail a statement to th e 
faoility showing a total fine for each violation and 
a total of fin e s du e to b e paid for all violations. 
Th e faoility s hall pay th e p e nalty within 60 days 
unl e ss a hearing is r e qu e st e d under G.S. Chapter 
450B, 

{g) — Wh e n it is found that a violation of G.S. 
13 IE 117 has ooouir e d but corr e ctiv e aotion was 
tak e n prior to th e dat e of discovery, fin e s shall be 
calculat e d and ass e s se d in accordanc e with ( e ) and 
(f) of this Rul e . 

{a) In matters of pati e nt abuse, — n e glect or 

misappropriation the definitions shall hav e th e 
meanings — d e fin e d — far — abus e , — n e glect — and 
e xploitation respectively as contain e d in th e North 
Carolina PROTECTION OF THE ABUSED, 
NEGLECTED OR EXPLOITED DISABLED 
ADULT ACT, G.S. 10 8 A 99 ot soq. 



Authority 
(e)(2)(B). 



G.S. 131E-79; 42 U.S.C. 1396 r 



.1927 



BRAIN INJURY LONG-TERM CARE 
PHYSICIAN SERVICES 



looat e d 



{a) For nursing faoility — pati e nts — looated — m 

d es ignat e d brain injury long term ooro units, there 
shall b e an att e nding physioian who is r e sponsibl e 
for tho pati e nt's sp e cializ e d car e program. — The 
int e nsity of th e program r e quir es that ther e shall bo 
dir e ct pati e nt contact by a physioian at least onoo 
p e r w ee k and mor e oft e n as tho patient's condition 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1757 



PROPOSED RULES 



warranto. Eaoh — pati e nt's — int e rdisciplinary, 

long term oar e program s hall b e d e v e lop e d and 
impl e m e nt e d under tho sup e rvision of a physiatrist 
(a physician trained in Physical — M e dioin e and 
Rehabilitation) — ef — a — physician — ef- — e quival e nt 
training and oxporionoe. 

{b) — If a physiatrist or physician of e quival e nt 
training or e xp e ri e nc e , is not availabl e on a w ee kly 
basis to th e facility, th e faoility shall provid e for 
weekly m e dioal manag e m e nt of th e pati e nt, by 
another physioian. — In addition, ov e rsight for the 
pati e nt's interdisciplinary, long term oar e program 
sbaH — be — provid e d — by — a — qualifi e d — consultant 
physioian — whe — visits — pati e nts — monthly, — mak e s 

r e commendations fef — and approv e s the 

int e rdisciplinary eafe plan, and provides 

consultation as r e quest e d to th e physioian who is 
managing tho patient on a weekly basis. 

(e) The — att e nding — physician — shati — activ e ly 

participate in individual cas e confer e nc e s or oar e 
planning — sessions — aed — shaH — review — and — sign 
discharg e summaries and records within 15 days of 

pati e nt — disoharg e . Wh e n — patients — are — te — be 

discharged to e ith e r anoth e r h e alth oar e faoility or 
a resid e ntial s e tting th e att e nding physioian shall 
as s ur e that th e pati e nt has been provid e d with a 
discharg e — pten — which — incorporat e s — optimum 
utilization — ef- — community — r e souro e s — and — pest 
di s charg e continuity of oare and services. 

Statutory Authority G.S. 131E-79. 



.1928 BRAIN INJURY LONG-TERM CARE 
PROGRAM REQUIREMENTS 

(a) Th e g e n e ral r e quir e m e nts in thi s Subchapter 
shall apply — wh e n applicabl e , — but brain injury 
long term oar e units shall m ee t th e supplem e nt 
r e quir e m e nts in this Rule and Rul e s .1901 ( 4 ) and 
.1929 of this S e ction. — Brain injury long term car e 
is — an — interdisciplinary, — int e nsiv e — maint e nance 
program for pati e nts who hav e inourr e d brain 
damag e caus e d by e xternal physioal trauma and 
whe — have — compl e t e d — a — primary — cours e — ef 
rehabilitativ e tr e atm e nt and have r e ach e d a point of 
ne — gain or — progre s s — fef — mor e — then — tbfee 

cons e cutiv e — months. S e rvic e s — afe — provid e d 

through a m e dically sup e rvis e d int e rdisciplinary 
proc e ss as provid e d in Rul e .1927 of this S e ction 
and ar e dir e ct e d toward maintaining th e individual 
at th e optimal l e v e l of physioal, oognitiv e and 

b e havioral — functioning. Following — afe — the 

minimum r e quir e m e nts for sp e oifio s e rvic e s that 
may b o n e c e ssary to maintaining th e individual at 
optimum l e v e l: 

<4-) Overall sup e rvisory r e sponsibility for 



brain injury long t e rm oaro oorvj o e 



shall b e assign e d to a registered nun* 



with one y e ar e xp e ri e nc e in oaring fe 
brain injur e d pati e nts 

(2) Physioal th e rapy shall bo provided by - 

physioal th e rapist with a curr e nt vob 



North Carolina license. — Qcoupation a 



therapy — shaH — be — provided — by- 
oooupational th e rapist with a ourrop 



valid North Carolina License. — Tb 



s e rvio e e — of a physioal — therapist an 
occupational therapist shall b 



oombin e d — te — provid e — eae — full tim 



e quival e nt for e aoh 20 pati e nts. — Tfe 



assistanc e of a physioal th e rapy aid 
and an occupational therapy aido wit 



appropriate sup e rvision shaH — b 



oombin e d — te — provide — ene — full tim 
e quival e nt for e aoh 20 pati e nts. 



proportionate numb e r of hours shall b 



provid e d for a c e nsus l e ss than 



m- 



pati e nts. 

Clinioal — nutrition — services — shall b 



provid e d by a qualifi e d di e tician wit 
twe — y e ar s clinical — training 



-as 



e xp e ri e nc e in nutrition. Th e number c 



hours of clinical nutrition services o 



e ith e r — a — full tim e — ef — part tim 
employm e nt or contract basis shall b 



ad e quat e to — m ee t th e n ee ds of th 
pati e nts. Each pati e nt's nutrition n ee d 



shaH — be — r e vi e w e d at — least — monthly 
Clinioal nutrition s e rvices shall inolude 



(A) — Ass e ssing th e appropriat e n e ss of tb 
ordered diet — for oonformanoo witl 



eaeh — pati e nt's — physiological — a» 

pharmacological oondition; 

(B) — Evaluating eaoh pati e nt's laborator 

data in relation to nutritional statu 



and hydration; 



{€-) — Applying — technical — knowledg e — e 



/implying i p uimiuui imu v viwige — o 

feeding tubes, pumps and oquipmei 
to e aoh pati e nt's sp e cialized ne e ds. 

'linionl — £nninl — Wnrlf nhnll — hr > nrrwirl ft 



{4) Clinical Sooial Work shall bo provid e* 

by — a — Social — Work e r — meeting — ft 



r e quir e m e nts — of Rul e — .1923 — of thi 
S e otion. 



{§) Recr e ation — th e rapy, — wh e n — requir e d 

shall b e provid e d on e ith e r a full tim< 



or part tim e e mploym e nt or oontrao 
basis — by — a — clinician — e ligibl e — fe 



c e rtification as a th e rap e utio reoroatioi 



sp e cialist — by — the — State — Board — e 
Th e rap e utio — R e cr e ation — Certification 



Th e number of hours of thorap e ut i 



1758 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



recr e ation oervio es shall b e ad e quat e to 
moot th e nood3 of th e pati e nts. — In th e 
ovont that a qualified sp e cialist io not 
locally — availabl e , — alt e rnat e — tr e atm e nt 
modaliti e s shall bo develop e d by th e 
occupational th e rapist and r e vi e w e d by 
the att e nding physician. — Th e program 
dosignod must b e adequat e to m e et th e 
n ee ds of this sp e cializ e d population and 
must bo administ e r e d in aooordano e 
with S e ction .1200 of this Subchapt e r. 

{£) Spoooh th e rapy, wh e n r e quired, shall be 

provid e d by a clinician with a ourrent 
valid lio e ns e in spoooh pathology issu e d 
by th e State Board of Audiology and 
Spoooh Pathology. 

{7) Respiratory — th e rapy, — wh e n — requir e d, 

shall b e provid e d and sup e rvis e d by a 
respiratory th e rapi s t curr e ntly r e gist e r e d 
by th e National Board for R e spiratory 
Car e . 
b) Each pati e nt' s program shall b e gov e rn e d by 



interdisciplinary tr e atm e nt plan incorporating 
d expanding upon th e h e alth plan r e quir e d und e r 



ilea .190 8 and .1909 of this Section. The plan 



jlinary proo e ss — th e tr e atm e nt — plan shall — be 
'iowod at least monthly and revis e d as appropri 



* — In e x e outing th e tr e atment plan tho intordiooi 
inary t e am shall b e th e major d e cision making 



ogram . — Disciplin e s to be represented on tho 
un shall b e m e dioin e , nursing, clinical pharmacy 



id all oth e r disciplines dir e ctly involv e d in the 
iti e nt's treatm e nt or tr e atm e nt plan. 



to b e initiat e d on th e first day of admission. 
jon completion of bas e lin e data d e v e lopment and 



int e grated interdisciplinary assessm e nt th e initial 
aatm e nt plan i s to b e e xpand e d and finaliz e d 



thin 1 4 days of admission. Through an int e rdis 



i dy and shall d e t e rmin e th e goals, proo e ss, and 
no fram e s for aooomplishm e nt of each patient's 



(e) — Eaoh pati e nt' s ov e rall program shall b e 
sign e d to an individually d e signat e d case manag 



Tho oaso manager acts as th e coordinator 
onager for assigned pati e nts. — Any prof e ssional 



iff memb e r involv e d in th e pati e nt's care may bo 
sign e d this r e sponsibility for on e or more pa 



i nto. Prof e ssional staff may divide this r e sponsi 
lity for all patients on tho unit in the b e st manner 



meet all patients' — needs — for a coordinated 



t e rdiooiplinary approaoh to oaro. Tho oaso man 



; e r shall bo responsibl e for: 
4^ coordinating th e developm e nt, imple 

mentation and periodic r e vi e w of tho 

patient's tr e atm e nt plan; 
{2} pr e paring a monthly summary of tho 



m- 



patient's progress; 

cultivating th e pati e nt's participation in 

tho program; 
{4) g e n e ral sup e rvision of th e pati e nt dur 

ing tho cours e of tr e atm e nt; 
{§) evaluating appropriat e ness of th e treat 

ment plan in r e lation to th e attainm e nt 

of stat e d goals; and 
{6) assuring that discharg e d e oisions and 

arrangem e nts fer pest di s charge 

follow up are prop e rly made. 
£d} — For e aoh 20 pati e nts or fraotion thereof 
d e dicat e d treatm e nt facilities and e quipm e nt shall 
b e provid e d as follows: 

(4^ A combin e d th e rapy spac e e qual to or 

oxoooding 600 squar e f ee t, ad e quat e ly 

e quipp e d and arrang e d to support eaoh 

of tho therapies. 

Aoo e ss to on e full r e clining wh ee lchair 



m- 



p e r pati e nt. 

Sp e cial physical th e rapy and oooupa 



Vh 



tional th e rapy e quipm e nt for us e in 
fabricating positioning d e vic e s for beds 
and wh ee lchairs including splints, ca s t s , 
cushions, wedges, and bol s t e r s . 

(4) Th e r e shall bo roll in bath facilities 

with a dr e ssing area available to all 
patients which shall afford maximum 
privacy to th e pati e nt. 

Statutory Authority G.S. 131E-79. 



.1929 SPECIAL NURSING REQUIREMENTS 
FOR BRAIN INJURY LONG-TERM 
CARE 

Dir e ct — ewe — nursing — p e rsonn e l — staffing — ratie 
(NH/PD) e stablish e d in Rul e .1912 of this S e ction 
shall not b e appli e d to nursing servic es for pati e nts 
who r e quir e brain injury long term car e , due to 
their — mor e — int e nsiv e — maint e nanc e — and — nur s ing 
n ee d s . — Th e minimum dir e ct care nursing staff 
shall b e 5.5 hrs. p e r pati e nt day allooated on a per 
shift basis as th e facility ohoos e s to appropriat e ly 
m ee t th e pati e nt's needs. — It is also required that 
regardl e ss of how low th e pati e nt census the dir e ct 
car e nursing staff shall not fall b e low a r e gister e d 
nurs e and a nurs e aid e I at any tim e during a 
2 4 hour p e riod. 

Statutory Authority G.S. 131E-79. 

.1930 VENTILATOR DEPENDENCE 

Th e g e n e ral r e quir e m e nts in this Subohapt e r shall 

apply wh e n applicabl e . In addition, faciliti e s 

having pati e nts r e quiring th e us e of v e ntilators for 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1759 



PROPOSED RULES 



mor e than e ight hours a dny — muot moot th e 
following requirements: 

{+) R e spiratory th e rapy shall b e provid e d and 

sup e rvis e d — by — a — respiratory — th e rapist 
ourrently — r e gist e r e d — by — the — National 

Board — fef — R e spiratory — Car e . The 

respiratory th e rapist shall: 

(a) make, as a minimum, weekly on sito 

ass e ssm e nts of each pati e nt receiving 
v e ntilator support with corresponding 
progr e ss not e s; 

(b) b e on call 24 hours daily; and 

(e) assist the pulmonologist and nursing 

Gtaff in establishing v e ntilator polioi e s 
and prooedur e s, — including e m e rg e ncy 
polioios and procedur e s. 

(2-) Dir e ct nursing oaro staffing shall bo in 

acoordanoo — with — RttJe — .1912 — ef- — th« 
S e otion, 



Statutory Authority G.S. 131E-79. 

.1931 PHYSICIAN SERVICES FOR 
VENTILATOR DEPENDENT 
PATIENTS 

Hospitals — with — nursing — facility — beds — with 
v e ntilator d e pend e nt car e pati e nts shall contract 
with a physician who is lio e ns e d to practic e in 
North Carolina with Board Certification and who 
has sp e cializ e d training in pulmonary m e dicin e . 
This physioian shall be r e sponsibl e for r e spiratory 
services and shall: 

{4-) establish, with th e r e spiratory th e rapist 

and nursing staff, appropriate v e ntilator 

polioi e s — asd — proo e dur e s, including 

e m e rgenoy proo e dur es ; 

(2-) assess oaoh ventilator pati e nt's status at 

least monthly with corr e sponding 

progress notes; 

0) be availabl e on an e m e rg e noy basis; and 

{4) participat e — m — individual — pati e nt — ease 

planning r 

Statutory Authority G.S. 131E-79. 

.1932 EMERGENCY ELECTRICAL 
SERVICE 

{a) — A minimum of on e d e dicated emergency 
branoh circuit per b e d is r e quir e d for v e ntilator 
dep e nd e nt pati e nts in addition to th e normal syst e m 
r e c e ptaol e at e aoh b e d location r e quired by th e 
National El e otrioal Cod e . — This e m e rg e noy oirouit 
shall bo provided with a minimum of two dupl e x 

reoeptaolos identifi e d fef e m e rg e noy user 

Additional em e rg e noy branoh oirouits/roo e ptaolos 



shall b e provid e d wh e re th e e l e otrioal life oup p e 
needs — ef — the — pati e nt — oxocod — th« — miaiffltt 



r e quir e m e nts — stated — in this — Paragraph: Een 

e m e rg e noy oirouit s e rving ventilator doponde 



pati e nts shall b e f e d from the automatically tnua 



f e rr e d oritioal branoh of th e e ssential oleotritf 



sy s t e m. — This Paragraph shall apply to both n e 



and e xisting facilities. 
{b) — Heating e quipm e nt provided for vontilafa 



d e p e nd e nt pati e nt b e drooms shall b e oonnootod - 
th e oritioal branoh of th e essential eleotrioal oyoto 



and arranged for delayed automatic or manu 
oonn e otion to th e em e rgenoy power oouroo if tl 



h e ating e quipment depends upon e l e ctricity $ 



prop e r op e ration. — This Paragraph shall apply 
both n e w and e xisting facilities. 
{e) — Task lighting oonn e ot e d to th e automatical 



transf e rr e d oritioal branoh of the ess e ntial elootrio 



syst e m shall b e provid e d for e aoh v e ntilator dope 
d e nt pati e nt b e droom. — This Paragraph shall app^ 



to both n e w and e xisting faoiliti e s 

Statutory Authority G. S. 131E-79. 

SECTION .2000 - SPECIALLY 
DESIGNATED UNITS 

.2001 ADMISSIONS TO THE HTV 
DESIGNATED UNIT 

If a facility d e clines admission to a pati e nt know 



to hav e Human Immunodeficiency Virus disoaa 
th e r e asons for th e d e nial shall b e docum e nt e d. 



Statutory Authority G.S. 131E-79. 

.2002 DISCHARGE OF PATTENTS FROM 
THE HTV DESIGNATED UNIT 

A record shall be maintained of all discharged t 



pati e nts indicating th e r e asons for discharg e , th 
physician's ord e r for or oth e r authorization fc 



discharg e , and th e condition of the patient at th 
timo of disohorgo. 



A pati e nt known to hav e Human Immunodef 
oi e noy Virus dis e as e may not b e discharged ool e l 



on th e basis of th e diagnosis of Human Immunol 
fioionoy Virus dis e as e e xo e pt as authorized by th 



provisions of N.C. G e n e ral Statute 13 IE 117 (1 



or oth e r provisions of th e N.C. G e neral Statutoo o 



regulations promulgat e d th e r e und e r or provision 
of applicable f e d e ral laws and r e gulations. 

Statutory Authority G.S. 131E-79. 

.2003 HTV DESIGNATED UNTT POLICIES 
AND PROCEDURES 



1760 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



a) In unite d e dicated to th e tr e atm e nt of pati e nts 
th Human — Immunodofioionoy — Virus — disease, 
lioioo and proo e dur e e sp e eifio to th e s p e cializ e d 



cdo of the patients s e rv e d shall b e d e v e lop e d. 



■ a minimum th e y shall include staff training and 



uontion, and th e availability of consultation by a 



ysioian with sp e cializ e d e duoation or knowl e dge 
■ tho manag e m e nt of Human Immunodeficiency 



ruo dis e as e . 



[b) Polioies and proc e dur es for infection oontrol 



all be in — conformanc e with 29 CFR 1910 



sc 



upational Saf e ty and H e alth Standards which is 
oorporated by r e fer e no e inoluding subs e quent 
londmonto. Emphasis — shall — be — plac e d — en 



mplianoe with 29 CFR 1910 1030 (Bloodbourn e 
ihog e ns). — Copi e s of Title 29 Part 1910 may b e 



irohascd from th e Superintend e nt of Dooum e nts, 
& — Governm ent — Printing — Offic e , — Washington, 



oalth S e rvice whioh is incorporat e d by r e f e r e no e 
oluding subs e qu e nt am e ndm e nts. Copies may b e 
irohas e d from the National Teohnioal Information 



s rvio e , U.S. D e partm e nt of Commerce, 52 8 5 
)rt Royal Road, Springfi e ld, Virginia, 22161 for 
-St9^ 



C. 20102 for $3 8 .00 and may b e purohased with 
orodit oard by a dir e ct t e lephone call to tho 



P.O. at (202) 7 8 3 323 8 . Infeotion oontrol shall 



so b e in oompliano e with th e C e nt e r of Dis e as e 



antrol — Guid e lin e s — as — publish e d by — the — fe^Sr 
opartm e nt of H e alth and Human S e rvic e s, Public 



atutory Authority G.S. 131E-79. 

004 PHYSICIAN SERVICES IN A fflV 
DESIGNATED UNIT 

In faciliti e s with a Human Immunod e fio 



l e ncy 



irus d e signated unit th e facility shall insur e that 



t e nding — physioians — have — docum e nt e d, — pre- 



ronged acc e ss, e ith e r in p e rson or by telephone, 
a physician — with — specialized — e duoation — er- 



lowl e dge — m — the — manag e m e nt — ef- — Human 



imunod e fioi e noy Virus Disease. 

atutory Authority G.S. 131E-79. 

005 SPECIALNURSINGREQUIREMENTS 
FOR A fflV DESIGNATED UNIT 



{a) — Faciliti e s with a Human Immunodofioionoy 
irus designated unit shall hav e a r e gist e r e d nurse 



ith specialized e duoation or knowl e dg e in tho 
ir e of Human Immunodefici e ncy Virus dis e as e . 



(b) — Nursing personnel assigned to tho Human 



nmunodofioionoy Virus unit shall bo regularly 
i signod to th e unit. — Rotations aro aoooptabl e to 



l e viato staff burnout or staffing omorg e noi e s. 



Statutory Authority G.S. 131E-79. 

.2006 SPECIALIZED STAFF EDUCATION 
FOR THE HTV DESIGNATED UNIT 

For faoilitios with a Human Immunodofioionoy 
Virus d e signat e d unit an organiz e d, docum e nt e d 
program — of eduoation — s p e cific — te — the — safe — ef 

pati e nts infect e d with — frn-e — Human 

Immunod e fici e ncy Virus shall b e provid e d and 
includ e at a minimum: 
(4-) Human — Immunod e fici e ncy — Virus — and 

Acquir e d Immune Deficiency Syndrom e 

disease processes; 

transmission mod e s, onus e s, and 

prevention of Human Immunod e fioienoy 

Virus; 

treatment of Human Immunod e fioi e noy 

Virus and Acquir e d Immun e D e ficiency 

Syndrom e ; 



(4)- 



psyoho socio e oonomio — n e eds — ef- — the 
Human — Immunodefioi e noy — Virus — and 
Aoquired Immune Deficiency Syndrome 
pati e nts; 

(S) is — addition — te — the — gon e ral — hospital 

orientation to Occupational Safety and 
Health — Administration — guid e lin e s — fef 
univ e rsal — precautions, — ori e ntation — te 
infeotion — oontrol — sp e cific — te — Human 
Immunod e fioi e noy Virus diseas e mu s t be 
provid e d upon e mploym e nt or permanent 
assignm e nt to th e unit; Copies of Titl e 29 
Part 1910 may b e purohas e d from tho 
Superint e nd e nt — ef- — Dooum e nts, — tJrSr 
Gov e rnm e nt Printing Office, Washington, 
DC. 20 4 02 for $3 8 .00 and may b e 
purohas e d with a cr e dit oard by a dir e ct 
telephone oall to th e G.P.O. at (202) 7 8 3 
3248- 

(6) polioi e s and proc e dures sp e cific to th e 

Human Immunod e fioienoy Virus 

d e signat e d unit; and 

(7) annual continuing e duoation in infeotion 

oontrol . 



Statutory Authority G.S. 131E-79. 

.2007 USE OF INVESTIGATIONAL DRUGS 
ON THE HIV DESIGNATED UNIT 



(a) — The- 



for th e 



-the 



sup e rvision and monitoring 
administration — ef- — investigational — drugs — is- 
r e sponsibility of th e pharmacist and a lic e ns e d 
r e gist e r e d nurse, noting pursuant to th e orders of 
a — physician — duly — authorized — te — pr e sorib e — ef 

dispense — sueh — drugs. R e sponsibilities — sfieH 

inolude, but not b e limit e d to, th e following: 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1761 



PROPOSED RULES 



{+) te — insur e — th« — provioion — ef- — writt e n 

guid e lin e s for any inv e otigational drug 
or study are provid e d; and 

(3) training — and — determination — of staff's 

abiliti e s — r e garding — administration — ef 

drugs, — polioi e s — and — proc e dur es — and 

regulations, 

(b) — The pharmacist or physician disp e nsing th e 

inv e stigational drug is to provid e th e facility with 

information r e garding at least th e following: 

(4-) a oopy of th e protoool, including drug 



&- 



informat ie&t 
-a — oopy — ef— 
oonsont; 
drug storag e ; 



-the — pati e nt's — inform e d 



{4) handling; 



£)- 



any 



sp e cific 



pr e paration b-fk 



&- 



&- 



administration instructions; 

sp e cific d e tails for drug aooountability, 

resupply and r e turn of unus e d drug; 



-a — oopy — ef- — the — sign e d — oons e nt — te 
participat e in th e study. 
{e) — Lab e ling of inv e stigational drugs shall b e in 
aooordanoe with writt e n guid e lin e s of protoool and 
Stat e — and — federal — r e quir e m e nts — r e garding — suoh 
drugs. Pr e scription lab e ls for inv e stigational drugs 
ar e to b e distinguishable from oth e r lab e ls by an 
appropriat e leg e nd, "Inv e stigational Drug" or "For 
Investigational Us e Only". 

Statutory Authority G.S. 131E-79. 

.2008 SOCIAL WORK SERVICES IN A HTV 
DESIGNATED UNIT 

The — facility — shall — provid e — e ith e r — by — dir e ot 
e mploym e nt — ef — by — contract — fef — social — work 
s e rvioes to includ e assistanc e to th e pati e nt in 
id e ntification — of supportiv e — r e sourc e s, — financial 
s e rvio e s and assistanc e with discharg e and transf e r 

arrang e m e nts. In addition, — for pati e nts — in a 

Human Immunod e fici e ncy Virus disease designated 
unit, th e sooial work e r shall provid e or arrang e for 
the — provi s ion — ef- — spiritual, — pastoral — and — gri e f 
couns e ling for pati e nts and staff wh e r e appropriat e - 
Support — servic e s — shall — b e provid e d to — patient 
famili e s and significant oth e rs. — Wh e r e n e c e ssary, 
coordination with tr e atm e nt servio e s for substano e 
abus e , — legal — se rvice s — and — other — community 
resourc e s shall b e id e ntifi e d. 



Statutory Authority G.S. 131E-79. 

RULES .2009 - .2019 RESERVED 
FOR FUTURE CODD7ICATION 



.2020 DEFINITIONS 

Th e following d e finition s shall apply to inpati u 
r e habilitation faoiliti e s or units only: 



w- 



m- 



(4)- 



m- 



cs- 






'Cas e manag e ment" m e an s — tl 



coordination of se rvio es , — for a gjy 
patient, b e tween disciplines do that tl 



patient may roach optimal rohabilitatk 



through th e judioious use of rooouroo s- . 



(3) "Compreh e nsive, inpati e nt rohabilita t t 



program" — m e ans — a — program — for t l 



treatment — of p e rsons — with — funotioa 



limitations or ohronio disabling oonditi e i 



who — have the pot e ntial — te — achieve 



significant improv e m e nt in activities - 



daily living. 



— A — eomprohonoivi 
r e habilitation program utilizes 



ooordinated a-a-d intograto< 

int e rdi s ciplinary approach, dir e cted by 



physician, to assess pati e nt needs and 
provid e — tr e atm e nt — and — e valuation 



physioal, — psycho sooial — and — oognitn 
d e ficits. 



"Inpati e nt r e habilitation facility or uni 
moans a free standing facility or a ud 



(unit p e rtains to — contiguous dedicate 
beds — and — spaoes) — within — an e xiotin 



lio e ns e d h e alth s e rvic e facility approve 
in aooordano e with G.S. 13 IE, Artiolo 



to establish inpati e nt, r e habilitation boc 



and to provid e a compr e h e nsiv e , inpatioi 

r e habilitation program. 

"M e dioal consultations" — m e an 



consultations — which — the — rehabilitatio 



physician — ef — the — att e nding — physieio 



d e t e rmin e ar e n e c e ssary to m ee t th e aout 



m e dioal n ee ds of tho patient and do nc 
includ e routin e medical needs. 



"Qooupational — th e rapist" — m e ans — m 
individual lio e ns e d in th e State of Nort 



Carolina as an occupational therapist 
aooordano e with th e provisions of G. 



90, Artiol e 1 8 D. 



"Qooupational therapist assistant" m e an 
any individual lio e ns e d in tho State o 



North — Carolina — as — an — oooupationo 
th e rapi s t assistant in aocordanoo with fit 



provisions of G.S. 90, Artiol e 1 8 D. 



"Psychologist" m e ans a poroon lioonse< 



as a praotioing psychologist in aooordano 
with G.S. 90, Artiol e 18 A. 



"Physiatrist" m e ans a lio e nsed phyoioia 
who has oompl e t e d a physioal modioin 



ane! — r e habilitation — r es id e ncy — tfajaaj 
program — approv e d by th e — Aooroditin; 



1762 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



(44)- 



£§)- 



Counoil of Graduate Medical Eduoation 
or th e American Ooteopathio Association. 
"Phyoioal th e rapiot" moano any poroon 



lioonsod in th e Stato of North Carolina as 
a phyaioal th e rapiot in aooordanoe with 
tho provisions of G.S. 90, Articl e 1 8 B. 



(10) "Phyoioal therapist assistant" moano any 

person duly lio e no e d in tho State of North 
Carolina a s a physical thorapiot aooiotant 
in aooordano e with tho provioiono of G.S. 
90 270.24, Artiol e 1 8 B. 

(14) "Rooroational th e rapiot" moans a person 

oortifi e d by the Stat e of North Carolina 
Thorap e utio — R e cr e ational — C e rtification 
Board. 



(13) "Rehabilitation nurs e " m e ans a rogiotor e d 

nurs e lic e ns e d in North Carolina, with 
training, e ith e r aoadomio or on the job, in 
physical — r e habilitation — nursing — and — at 
least on e y e ar e xp e ri e nc e in physical 
rehabilitation nursing. 

(13) "Rehabilitation aid e " moans an unlic e ns e d 



assistant whe works under — the 

supervision — ef- — a — r e gist e r e d — nurse, 
lio e no e d — physioal — th e rapist — e-r- 
oooupational th e rapist in aooordano e with 
th e appropriat e — occupational — lio e nsur e 
laws gov e rning his or h e r sup e rvisor and 
oonoiotent with staffing r e quirement!) as 
oot forth in Rule .2027 of this S e ction. 
Th e rehabilitation aide shall b e list e d on 
th e North Carolina Nuroe Aide R e giotry 
and hav e r e c e iv e d additional otaff training 
as listed in Rul e .202 8 of this S e otion. 
"Rehabilitation — physioian" m e ans — a 



-« 



physiatrist — e* — a — phy s ioian — who 
qualified, bas e d on e duoation, training 
and exp e ri e nc e r e gardless of opooialty, of 
aiding m e dioal care to rehabilitation 



providing 

pati e nts. 

"Sooial worker" m e ans a p e rson oortified 



by the North Carolina Certification Board 
for Sooial Work in aooordano e with G.S. 
90B 3. 



(44) "Sp e ech and languag e pathologist" means 

any poroon lic e ns e d in tho Stat e of North 
Carolina — as — a — spoooh — and — languag e 
pathologist — m — aooordano e — with — the 
provisions of G.S. 90, Artiol e 22. 

tatutory Authority G.S. 131E-79; 143B-165. 



2021 PHYSICIAN REQS FOR INPATIENT 
REHABILITATION FACILITIES 
OR UNITS 



(a) In a r e habilitation facility or unit a phyoioian 
shall partioipato in the provision and management 
of r e habilitation servic e s and in th e provision of 
m e dioal s e rvioeo. 

(b) In — a — r e habilitation — faoility — ef — unit — a 

r e habilitation physioian shall b e r e sponsible for a 
pati e nt's interdisciplinary tr e atm e nt plan. — Eaoh 
pati e nt's int e rdisciplinary treatm e nt plan shall b e 
develop e d and impl e m e nt e d und e r th e sup e rvision 
of a r e habilitation physioian. 

(o) Th e r e habilitation physician shall participat e 
in th e pr e liminary ass e ssm e nt within 48 hours of 
admission, pr e pare a plan of oare and dir e ct th e 
necessary — frequency — of contact — based — en — the 
m e dioal and r e habilitation n ee ds of th e patient. 
The frequency shall b e appropriat e to justify th e 
ne e d for compr e h e nsiv e inpatient — rehabilitation 

(d) — An inpati e nt r e habilitation faoility or unit's 
oontract — ef — agr e em e nts — with — a — r e habilitation 
physioian — shall — r e quir e — tbat — the — r e habilitation 
physioian — s hall — partioipato — m — individual — ease 
conferenc e s or oare planning s e ssions and shall 
review and sign disoharg e summari e s and r e oords. 
Wh e n pati e nts ar e to b e discharg e d to another 
health oar e faoility, th e discharging faoility shall 
assure that th e pati e nt has boon provided with a 
disoharg e plan whioh incorporat e s post disoharg e 
oontinuity of oare and servioos. Wh e n pati e nts ar e 
to be discharg e d to a resid e ntial s e tting, th e faoility 
shall assure that th e pati e nt has boon provid e d with 
a disoharg e plan that incorporates th e utilization of 
community r e souro e s when availabl e and wh e n 
includ e d in th e pati e nt's plan of oar e . 

(e) — Th e intensity of physioian m e dioal s e rvic e s 
and the fr e qu e ncy of regular oontaots for m e dioal 
oar e for the pati e nt shall b e d e t e rmin e d by the 
pati e nt's pathophysiologic n ee ds. 

(f) Wh e r e th e att e nding physioian of a patient in 
an inpatient rehabilitation faoility or unit ord e rs 
m e dioal — consultations — fef — the — pati e nt, — such 
consultations — shall — be — p rovid e d — by — qualified 
physicians — within — 48 — hours of th e physician's 
ord e r. — In ord e r to achi e v e this r e sult, th e contracts 
ef — agr ee m e nts — b e tw ee n — inpati e nt — r e habilitation 
faciliti e s or units and medioal consultants shall 
requir e that suoh consultants rend e r the r e quest e d 
medioal consultation within 48 hours. 

(g) — An inpati e nt r e habilitation faoility or unit 
shall hav e a writt e n proc e dur e for s e tting th e 
qualifications of th e physicians r e nd e ring phyoioal 
r e habilitation oerviooo in tho faoility or unit. 

Statutory Authority G.S. 131E-79; 143B-165. 



NORTH CAROLINA REGISTER 



February 1, 1995 



1763 



PROPOSED RULES 



.2022 ADMISSION CRITERIA FOR 
INPATIENT REHABILITATION 
FACILITIES OR UNITS 



-fef 



{a) — Th e facility ohall hav e writt e n orit e ria 
admi ss ion to th e inpati e nt r e habilitation facility or 
twit — A d e scription of programs or s e rvic e s for 
aor e ening the suitability of a giv e n pati e nt for 
placement s hall be availabl e to staff and referral 
s ourc es . 

{&) — For pati e nts found unsuitabl e for admission 
to th e inpati e nt r e habilitation faoility or unit, th e r e 
shall b e docum e ntation of th e r e asons, 

{e) — Within 4 8 hours of admission a pr e liminary 
ass e ssm e nt shall b e oompl e t e d by m e mbers of th e 
int e rdisciplinary t e am to insur e th e appropriateness 
of placem e nt and to identify th e imm e diate n e eds 
of th e pati e nt. 

{d} Pati e nts — admitt e d — te — aa — inpatient 

r e habilitation faoility — or unit must b e abl e to 
tolerate a minimum of throe hours of r e habilitation 
therapy, fiv e days a wook, including at l e ast two of 

the — following — r e habilitation — servic e s: physioal 

th e rapy, occupational th e rapy or speech therapy. 



(■)- 



Pati e nts — admitted — te — as — inpati e nt 



r e habilitation faoility or unit must b e m e dically 
stabl e , hav e a prognosis indicating a progressiv e ly 
improv e d m e dioal condition and have th e potential 
for increased indep e nd e nce. 



Statutory Authority G.S. 131E-79; 143B-165. 

.2023 COMPREHENSrVE INPATIENT 
REHABILITATION EVALUATION 

(a) — A compr e h e nsiv e , inpati e nt r e habilitation 
e valuation is r e quir e d for e aoh pati e nt admitt e d to 
an inpati e nt rehabilitation faoility or unit. — At a 
minimum this e valuation shall inolud e th e r e ason 
for referral, a summary of th e pati e nt's clinical 
oondition, funotional str e ngths and limitations, and 
indications for sp e oifio s e rvic e s. — This e valuation 
shall b e compl e t e d within thr ee days. 

{b) Eaoh pati e nt shall b e e valuat e d by the 

int e rdisciplinary t e am to determin e th e n ee d for 
any of th e following s e rvio e s: m e dioal, di e tary, 
oooupational th e rapy, physical th e rapy, prosth e tics 
and — orthotios, — psychological — ass e ssm e nt — asd 
therapy, — th e rap e utio — r e or e ation, — r e habilitation 
medicin e , — rehabilitation — nursing, — therapeutic 
couns e ling or social work, vocational r e habilitation 
evaluation and s pe e ch languag e pathology. 

Statutory Authority G.S. 131E-79; 143B-165. 



.2024 COMPREHENSrVE INPATIENT 
REHABILITATION INTER- 



DISCIPLINARY TREAT/PLAN 

(a) — Th e interdisciplinary tr e atm e nt toam -sb 
d e velop an individual tr e atm e nt plan for ea 
pati e nt within s e v e n days after admission. — ? 



plea — sfeaH — inolud e — e valuation — finding s — a 



information about th e following: 

ft) prior l e vel of function; 

(3) ourront funotional limitations; 

{£) sp e oifio s e rvic e n ee ds; 

(4) tr e atm e nt, supports and adaptations 



b e provid e d; 
{§) sp e cifi e d treatment goals; 



m- 



disciplin e s r e sponsible — f- 



impl e m e ntntion of s e parate parts of -4 

plan; and 

{^ anticipated — time — frames — fe? — | 



aooomplishm e nt of specifi e d long to 



and short term go afe- 



(b) Th e tr e atment plan shall b e reviewed by 
interdisciplinary team at l e ast e v e r)' othor we< 



All m e mb e rs of th e interdisciplinary team, oi 
r e pr e s e ntative of th e ir disciplin e , shall attend co 



mooting. Docum e ntation of e aoh r e view oh 

inolud e — progress — toward — d e fin e d — goals — a 



id e ntification of any chang e s in th e treatment pi 
(e) — Th e tr e atm e nt plan shall inolud e provisio 



for all of th e s e rvic e s id e ntified as n ee d e d for I 



pati e nt m the compr e h e nsiv e , inpatu 

r e habilitation e valuation oompl e ted in aooordai 



with Rul e .2023 of this Subchapt e r. 
(d) — Eaoh patient shall hav e a d e signated « 



manag e r who is responsible for th e coordination 
th e pati e nt's individualized tr e atm e nt plan. — 3 



oos e manag e r is r e sponsibl e for promoting t 
program' s — r e sponsiv e n e ss — te — th e n ee ds of I 



patient and shall participat e in all t e am oonferent 
conc e rning — the — pati e nt's — progr e ss — toward t 



aooomplishm e nt of specifi e d goals. — Any of I 
professional staff involv e d in th e pati e nt's oi 



may b e th e d e signat e d oas e manag e r for on e 
mor e oas e s, or th e director of nursing or soc 



work e r may acc e pt th e coordination r e sponsibil 
for th e patients. 

Statutory Authority G.S. 131E-79; 143B-165. 



.2025 DISCHARGE CRITERIA FOR 
INPATIENT REHABDLITATION 
FACILITTES OR UNITS 

{a) — Discharg e planning shall bo an integral pi 



of th e pati e nt's tr e atm e nt plan and shall begin up 



admission to th e facility. — After established go 
have boon reached, or a d e t e rmination has b e 



mad e that oar e in a loss intensive sotting would 



appropriat e , or that furth e r progress is unl ike 



1764 



NORTH CAROLINA REGISTER 



February 1, 1995 



9: 



PROPOSED RULES 



>■ patient shall be disoharg e d to an appropriat e 
ting: — Other r e asons for discharg e may includ e 



inability or unwillingn e ss of patient or family to 



operate with th e plann e d therap e utic program or 
s dioal — complications that pr e olud e a furth e r 



i onsivo r e habilitativ e e ffort. — Th e facility s hall 



rolvo the pati e nt, family, staff m e mb e rs and 



prral sources in discharg e planning. 



wharg e or transfer proc e ss in coordination with 



rility for further car e , appropriat e documentation 
the patient's ourr e nt status shall bo forwarded 



%) The — ease — manag e r — shell — facilitat e th e 



o facility social work e rs. 



e) — If a patient is b e ing r e f e rr e d to anoth e r 



ith the patient. — A formal discharg e summary 
all be forward e d within 48 hours following 



ooharg e — and — shall — inolud e — the — r e asons — fef 



ferral, — the — diagnosis, — functional — limitations, 



irvioos provid e d, th e r e sults of services, r e f e rral 
4ien — recomm e ndation s — and — activiti e s — and 



ooodur e s us e d by th e pati e nt to maintain and 
lprov e functioning. 



atutory Authority G.S. 131E-79; 143B-165. 

026 COMPREHENSIVE 

REHABILITATION PERSONNEL 
ADMINISTRATION 



{a) ?%e — facility — shaH — have — qualifi e d — staff 

emb e rs, consultants and contract p e rsonn e l to 



ovid e servic e s to th e pati e nts admitted to th e 
patient rehabilitation facility or unit. 



(b) P e rsonnel shall bo employ e d or provid e d by 



jntraotual — agr ee m e nt — m — suffici e nt — typ e s — and 



ambers to m ee t the needs of all pati e nts admitt e d 
r compr e h e nsiv e rehabilitation. 



Je) — Writt e n agr ee m e nts shall be maintain e d by 



, e facility wh e n s e rvic e s ar e provid e d by oontraot 



i an ongoing basis. 

'atutory Authority G.S. 131E-79; 143B-165. 

027 COMPREHENSIVE INPATIENT 
REHABILITATION PROGRAM 
STAFFING REQS 



*) — Th e staff of th e inpati e nt r e habilitation 
oility or unit shall inolud e at a minimum: 



(4-) The inpati e nt rehabilitation facility or 

Hfiit — shall — be — sup e rvis e d — by — a 
r e habilitation nurse. — Th e facility shall 
identify the nursing skills nec e ssary to 
moot the needs of th e r e habilitation 
patients in the unit and assign staff 
qualified to moot thos e n ee ds. 

{3) The minimum nursing hours p e r pati e nt 



in th e r e habilitation unit shall be 5.5 
nursing hours p e r patient day. — At no 
time shall dir e ot car e nursing staff b e 
l e es than two full tim e e quivalents, one 
of which must b e a r e gist e red nurse. 

0) The inpati e nt r e habilitation unit shall 

e mploy — ef — provid e — by — contractual 

agr ee m e nts suffici e nt — th e rapists, 

licensed in North Carolina, to provide 
a minimum of thr ee hours of spooifio 
(physical, occupational or s p e ech) or 
oombin e d rehabilitation th e rapy s e rvices 
p e r pati e nt day. 

(4) Physical th e rapy a ss i s tant s and 

oooupational th e rapy assistants shall b e 
lic e ns e d — ef — o e rtifi e d — and — shaH — be 
sup e rvis e d on site by lic e ns e d physical 
th e rapists — ef — lic e ns e d — oooupational 
th e rapists. 

{5) Rehabilitation aides shall have 

docum e nt e d training appropriat e to th e 
activiti e s — te — be — performe d — and — the 
oooupational lioonsur e laws of his or 



her- 



The ov e rall 



sup e rvisor. — 

r e sponsibility fef tke on going 

sup e rvision — and — e valuation — ef- — the 
r e habilitation — aide — r e mains — with — the 
regist e r e d — nurs e — as — id e ntifi e d — in 
Subparagraph — (a)(1) — ef- — this — Rul e - 
Sup e rvision by th e lioens e d physical 
th e rapi s t — ef — by — the — occupational 
th e rapist is limit e d to that tim e wh e n 
th e th e rapist is on sit e and dir e cting th e 
r e habilitation activiti e s of th e aid e . 

{6) Hours of s e rvic e by th e r e habilitation 

aide ar e count e d toward th e r e quir e d 
nursing hours when th e aid e is working 
und e r th e supervision of th e lio e ns e d 

nurs e . Hours — ef- — s e rvic e — by — the 

rehabilitation aid e ar e counted toward 
th e rapy hours during that tim e th e aid e 
works — und e r — the — imm e diat e , — on sit e 
supervision of th e — lioens e d — physical 
th e rapist — ef — oooupational — th e rapist. 
Hours of s e rvic e shall not b e dually 
oount e d for both servic e s. — Hours of 
s e rvic e — by — r e habilitation — aides — m 
p e rforming nurs e aid e duties in areas of 
th e faoility oth e r than th e r e habilitation 
unit shall not b e oount e d toward th e 5.5 
hour minimum — nur s ing r e quir e m e nts 
described for th e r e habilitation unit. 
{b) — Additional p e rsonn e l shall b e provid e d as 
r e quir e d to m ee t th e n ee ds of th e pati e nt, as 
d e fin e d i-H the compr e hensiv e , inpatient 



21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1765 



PROPOSED RULES 



r e habilitation e valuation. 

Statutory Authority G.S. 131E-79; 143B-165. 

.2028 STAFF TRAINING FOR INPATIENT 
REHABILITATION FACILITIES 
OR UNIT 

Prior to th e provision of oare, all r e habilitation 



.2030 PHYSICAL FACILITY REQS/ 
INPATIENT REHABILITATION 
FACILITIES OR UNITS 

(a) — Th e inpati e nt r e habilitation facility or a 



ohall b e in a d e signat e d ar e a and shall bo uoed - 



th e sp e oifio purpos e of providing a oomprohonsi 
inpati e nt rehabilitation program. 
{te) — The floor ar e a of a singl e bedroom ohall 



personnel, e xoluding physicians, as s ign e d to th e suffioi e nt for th e pati e nt or the staff to co s 



rehabilitation unit shall bo provided training or 
shell — provid e — docum e ntation — of training, — that 
include s at a minimum th e following: 
(4-) aotiv e and passiv e rang e of motion; 



(3) assistanc e with ambulation; 

{£) transf e rs; 



(4) maximizing funotional indep e nd e nc e ; 






-the psyoho social ne e ds ef- the 

r e habilitation pati e nt; 



th e increas e d saf e ty risks of r e habilitation 

training (inoluding falls and th e us e of 

r e straints); 

(?) prop e r body mechanics; 

(8) nutrition, inoluding — dysphagia — and 

restorative eating; 
(9) communication — with — the — aphasia — and 

hearing impaired pati e nt; 

b e havior modification; 






<m- 



bow e l and bladder training; and 
skin car e . 



Statutory Authority G.S. 131E-79; 143B-165. 

.2029 EQUIPMENT REQS/ 

COMPREHENSIVE INPATIENT 
REHABILITATION PROGRAMS 

(a) — Th e faoility shall provid e eaoh disciplin e 
with — the — n e o e ssary — e quipm e nt — aed — treatm e nt 
m e thods to achi e v e th e short and long t e rm goals 

sp e cifi e d m the compr e h e nsiv e inpati e nt 

r e habilitation int e rdisciplinary treatm e nt plans for 
patients admitt e d to these faciliti e s or units. 

fb) Eaoh — pati e nt's — n ee ds — fef — a — standard 

wh ee lchair or a sp e cially d e sign e d whe e lohair or 
additional devio e s to allow saf e and ind e p e nd e nt 
mobility within th e faoility shall b e m e t. 

(e) — Sp e cial physical th e rapy and occupational 
th e rapy — e quipm e nt — fef — use — m — fabricating 
po s itioning d e vioes for b e ds and whe e lchairs shall 
b e provid e d, inoluding splints, oasts, cushions, 
w e dg e s and bolsters. 

(d) — Physical therapy devices, including a mat 
tabl e , parall e l bars and sliding boards and sp e cial 
adaptiv e bathroom e quipm e nt shall b e provid e d. 

Statutory Authority G.S. 131E-79; 143B-165. 



transf e r th e pati e nt from th e b e d to a whoolob 



and — te — man e uv e r — a — 1 8 d e gr ee — tea — with 



wh ee lohair on at least on e side of the bod. 
(o) Th e floor ar e a of a multi b e d bedroom sh 



bo suffioi e nt for th e pati e nt or the staff to co» 



transfer th e patient from th e b e d to a whcoloh. 



aed — te — maneuver — a — 1 8 d e gr ee — tea — with 



wh ee lohair b e tw ee n b e ds. 

(d) — Eaoh pati e nt room shall 
r e quir e m e nts: 



moot the followi 



{¥) Maximum room oapaoity of no dm 

than four pati e nts; 
(3) Op e rabl e windows; 



(3) A nurs e oall syst e m design e d to m< 

the — sp e cial — needs — ef- — r e habilitati 



pati e nts; 
f4) le — singl e — aed — two b e d — rooms w 



privat e toil e t room, th e lavatory may 



locat e d in th e toil e t room; 
(§) A wardrob e or olosot for e aoh patk 



which — is — wheelchair — accessible 



(6)- 



arrang e d to allow th e patient to aoo e 

th e cont e nts; 

A oh e st of draw e rs or built in draw 



<?h 



storag e with mirror abov e , which 

wh ee lohair acc e ssibl e ; and 

A b e dsid e tabl e for toil e t articl e s a 



p e rsonal b e longings. 



(e) — Spac e for e m e rg e noy e quipment suoh 
r e suscitation oarts shall b e provided and shall 



und e r — dir e ct — oontrol — of th e — nursing — staffs 

proximity to the nurse's station and out of traffic 

(f) — Pati e nts' bathing facilities shall m e et t 

following sp e cifications: 

Th e r e shall b e at l e ast one shower et 



&- 



or on e bathtub for e aoh 15 bodo i 



individually — s e rv e d. Eaoh — tab- 

show e r shall b e in an individual roo 



or privacy e nclosur e whioh provic 
spao e for th e private us e of tho bathi 



fixtur e , for drying and dr e ssing and i 
a wh ee lohair and an assisting attondai 



(3) Show e rs — ie — o e ntral bathing fooiliti 

shall b e at l e ast fiv e foot square witho 



ourb s and design e d to p e rmit uoo by 
whe e lohair pati e nt. 



1766 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:. 



PROPOSED RULES 






0) At — least — ene — five foot by o e von foot 

shower shall be provid e d whioh can 
accommodat e — a — s tr e tch e r — and — an 
assisting attendant. 



g) — Patients' toilet rooms and lavatori e s shall 
x>t the following specifications: 



<$) The — size — of toil e ts — sbaH — permit — a 

whoolohair, a — staff — p e rson — and 

appropriat e — wheel to wat e r — clos e t 
transf e rs. 

{3) A lavatory in th e room must p e rm it 

whoolohair aoo e ss. 

0) Lavatori es s e rving pati e nts shall: 

{A) — allow wh e elohairs to e xt e nd und e r th e 

lavatory; and 
{B) — hav e water s upply spout mounted so 
that its discharge point is a minimum 
of five inohes abov e th e rim of th e 
fixtur e . 

(4) Lavatori e s us e d by pati e nts and by staff 

shall b e equipp e d with blad e op e rat e d 
supply valv e s. 



&) — The spaoo provid e d for physioal th e rapy, 
oupational th e rapy and speech th e rapy by all 



patient r e habilitation faciliti e s or units may b e 
arod but must, at a minimum, includ e : 



(i) office spao e for staff; 

{3) offio e — spao e — fef — spoooh — th e rapy 

evaluation and tr e atm e nt; 

0) waiting spao e ; 

{4) training bathroom whioh includes toil e t, 

lavatory and bathtub; 

{§) gymnasium or e x e rois e ar e a; 

(6) work ar e a suoh as tabl e s or counters 



suitabl e for wh ee lohair aoo e ss; 
tr e atm e nt ar e as with availabl e privaoy 
curtains or sor ee ns; 



&- 



(8) an activiti e s of daily living training 

kitoh e n with sink, cooking top (scoured 
wh e n — net — sup e rvis e d — by — staff), 
r e frig e rator — and — count e r — surface — fef 
m e al preparation; 

{9) storage for cl e an lin e ns, suppli e s and 

e quipm e nt; 

(W) — janitor's clos e t aooessible to the therapy 
ar e a with floor receptor or servic e sink 
and — storag e — spao e — fer — hous e k ee ping 
s uppli e s and e quipm e nt, on e clos e t or 
s pao e may s e rv e mor e than on e ar e a of 
the inpatient r e habilitation facility or 
unit; and 

{44) hand washing facilities. 



(i) — For social work and psychological s e rvic e s 



e following shall b e provided: 
{4} offio e spao e for staff; 



(3) offio e — spao e — for private — int e rviewing 

and oounsoling for all family mombors; 

{£) workspac e for t e sting, e valuation and 

couns e ling. 

<+) If prosth e tics and orthotics s e rvices arc 

provid e d, — the following — spac e — shell — be — made 
available as n e cessary: 

{+) work spaoo for t e ohnioion; and 

{3) spao e for e valuation and fittings (with 

provi s ions for privaoy). 
{k-) — If vooational th e rapy s e rvic e s ar e provided, 
th e following spao e shall b e mad e availabl e as 
n e c e ssary: 

{4-) offic e spao e for staff; 

{3) workspac e — fef — vooational — s e rvices 

activiti e s — seen — as — pr e vooational — and 
vooational evaluation; 

0) training spac e ; 

f4) storag e for e quipm e nt; and 

(S) couns e ling and plac e m e nt spac e . 

(!) R e cr e ational th e rapy — spao e r e quir e m e nts 

includ e th e following: 

{+) activities spaoo; 

{3) storag e for e quipm e nt and supplies; 

0) offio e spao e for staff; and 

aoo e ss to mal e and f e mal e toil e ts. 



<4)- 



{») — Th e following spao e shall b e provid e d for 
pati e nt's dining, r e creation and day areas: 

ft) suffici e nt room fef wh ee lohair 

movement — and — wh ee lohair — dining 
s e ating; 

(3) if- — feed — s e rvic e — is — oafeteria — typ e , 

ad e quat e width fef wh ee lohair 

man e uv e rs, — qu e u e — spao e — within — the 
dining area (and not in a oorridor) and 
a s e rving oount e r low e nough to vi e w 

0) total spao e for inpati e nts, a minimum of 

25 square foot per bed; 

{4) for outpatients participating in a day 

program or partial — day program, — 30 
squar e f ee t wh e n dining is a part of th e 
program and — W — s quar e — feet — when 
dining is not a part of th e program; and 

{£) storag e for r e creational equipm e nt and 

suppli e s, tabl e s and chairs. 
(n) — Th e pati e nt dining, recreation and day area 
spao e o shall be provided with windows that hav e 
glazing of an ar e a not less than e ight percent of the 
floor area of th e space. — At least on e half of th e 
r e quir e d window ar e a must b e op e rable. 

(e) — A laundry shall b e available and aooessible 
for pati e nts. 



.21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1767 



PROPOSED RULES 



Statutory Authority G.S. 131E-79; 143B-165. 

.2031 ADDITIONAL REQUIREMENTS FOR 
TRAUMATIC BRAIN INJURY 
PATIENTS 

Inpati e nt r e habilitation faciliti e s providing s e rvio 
e a to persons with traumatic brain injuri e s shall 
me e t th e r e quir e ments in this Rul e in addition to 
thos e id e ntifi e d in this S e ction. 

(4-) Dir e ct car e — nursing — p e rsonn e l — starring 

ratios e stablish e d in Rul e .2027 of thi s 
Section shall not b e appli e d to nursing 
services for traumatic brain injury pa 
ti e nts — m — the — inpati e nt, — r e habilitation 
facility or unit. — Th e minimum nursing 
hours per traumatic brain injury pati e nt 
in th e unit shall be 6.5 nursing hours p e r 
pati e nt day. — At no tim e shall dir e ct oar e 
nursing staff b e less than two full tim e 
e quival e nts, — one of which — shall b e a 
r e gist e r e d nurs e . 

{2} Th e inpati e nt r e habilitation faoility or unit 

shall e mploy or provid e by contractual 
agr e em e nts — physical, — occupational — ef 
speech therapists in ord e r to provid e a 
minimum of 4 .5 hours of sp e cific or 
oombinod r e habilitation th e rapy s e rvic e s 
p e r traumatic brain injury pati e nt day. 

{3) Th e faoility shall provid e special faoility 

or e quipment needs — for pati e nts — with 
traumatio brain injury, inoluding a qui e t 
room — fef — therapy, — sp e oially — d e signed 
wh ee lchairs and standing tabl e s. 
Th e — m e dical — dir e ctor — of an — inpatient 
traumatio brain injury program shall hav e 
two y e ars management in a brain injury 
program, on e of whioh may b e in a 
olinioal — f e llowship program and board 
e ligibility or oertifioation in th e m e dioal 
sp e cialty of th e physioion's training. 

(§) Th e faoility shall provid e th e consulting 

s e rvio e s of a n e uropsychologist. 

{6) The — faoility — sfeaH — provide — oontinuing 

e ducation in th e oar e and tr e atm e nt of 
brain injury pati e nts for all staff. 

f?) Th e size of the brain injury program shall 

b e ad e quat e to support a compr e h e nsiv e , 
d e dicat e d ongoing brain injury program. 



(4)- 



Statutory Authority G.S. 131E-79; 143B-165. 

.2032 ADDITIONAL REQUIREMENTS FOR 
SPINAL CORD INJURY PATDZNTS 

Inpati e nt r e habilitation faciliti es providing s e rvio 
e s to p e rsons with spinal oord injuri e s shall m ee t 



th e r e quir e m e nts in this Rul e in addition to tin 

id e ntifi e d in this Section. 

(1-) Dir e ct oar e — nursing — p e rsonnel — steffi 



ratios es tablish e d in Rule .2027 of tl 



S e ction shall not b e applied to nur s i 
s e rvic e s for spinal oord injury paticnte 



th e inpatient, — r e habilitation faoility - 
ttfiifc — The minimum nursing hours \ 



spinal oord injury pati e nt in the unit sh 



b e 6.0 nursing hours p e r pationt day. 
no tim e shall direct oare nursing staff 



l e ss than two full time e quivalents, ono 



whioh shall b e a register e d nurse. 
(2) Th e inpati e nt r e habilitation faoility or \i 



shall e mploy or provide by oontraoti 
agr ee m e nts — physical, — occupational 



speech th e rapists in ord e r to provide 
minimum of 4 .0 hours of specific 



combin e d r e habilitation therapy oorvic 



p e r spinal oord injury pati e nt day. 



(3) Th e faoility shall provid e op e oial faoil 

or s p e cial e quipment needs of patioi 



with spinal cord injury, inoluding spooi i 
ly d e sign e d wh ee lchairs, tilt tables a 



standing tabl e s. 



f4) The — m e dioal — dir e ctor of an inpati c 

spinal oord injury program shall ha 



e ith e r two y e ars e xp e ri e nc e in th e ma 
e&J — oare of p e rsons with spinal oo 



injuries or six month's minimum in 
spinal oord injury f e llowship. 






-The — faoility — sfeaH — provid e — oontinui 
e ducation in the oare and treatment 



spinal oord injury' patients for all staff. 



Th e faoility s hall provid e sp e oifio oti 
training and e ducation in th e oar e ai 



tr e atm e nt of spinal oord injury. 



Th e size of th e spinal oord injury pi 
gram — shall b e adequat e to support 



compr e hensive, dedicat e d ongoing spii 
oord injury program. 

Statutory Authority G.S. 131E-79; 143B-165. 



.2033 DEEMED STATUS FOR INPATIEN1 
REHABILITATION FACILnTES 
OR UNITS 



(a) — If an inpatient r e habilitation faoility or ui 



with — 6j — compr e h e nsiv e — inpati e nt — rehabilitate 
program is surv e y e d and accr e dit e d by th e Jo i 
Commission for th e Accr e ditation of Health Ca 



Organizations (JCAHO) or th e Commission - 
Accr e ditation of R e habilitation Facilities (CAR1 



and has been approv e d by th e Department 



accordance with Artiolo 9 Chapter 13 IE of t l 



1768 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:1 



PROPOSED RULES 



orth Carolina General Statutes, th e D e partm e nt 



s omo the faoility to b e in oompliano e with Rul e s 



IQ 20 through .2030 and .2033 of this S e ction. 



(b) De e med status shall be provid e d only if th e 
ipationt rehabilitation facility or unit provid e s 



jpioo of surv e y r e ports to the Division. — The 
IAHO report shall show that th e faoility or unit 



ma surveyed for r e habilitation servic e s. The 



ARF report shall show that th e faoility or unit 



•as — survey e d — for- — compr e h e nsiv e — rehabilitation 
Drvioes. Tho faoility — or unit shall — sign an 



groom e nt — (Memorandum — ef- — Und e rstanding) 
jooifying those t e rms. 



(e) — Tho inpati e nt r e habilitation faoility or unit 
baH — be — subj e ct — te — in s p e ctions — ef — oomplnint 



ivo s tigations by r e pres e ntativ e s of tho Department 
t any tim e . — If th e faoility or unit is found not to 



o in oompliano e with th e rul e s list e d in Paragraph 
1) of this Rul e , th e faoility shall submit a plan of 



orrootion and b e subj e ct to a follow up visit to 



ssuro complianc e . 



(d) If th e inpati e nt r e habilitation faoility or unit 
3606 or do e s not r e n e w its accr e ditation, th e 



loility or unit shall notify th e Division in writing 



e quirem e nts of this Subohapt e r shall apply to suoh 
lospitals e xoept whoro thoy ar e sp e oifioally waived 



vithin 30 days. 

tatutory Authority G.S. 131E-79. 

SECTION .2100 - SUPPLEMENTAL 

RULES FOR THE LICENSURE OF 

DESIGNATED PRIMARY CARE 

HOSPITALS AND FEDERALLY 

CERTHTED PRIMARY CARE HOSPITALS 



2101 SUPPLEMENTAL RULES 

Tie — rul e s — of this — S e ction — p e rtain — only — te 



l e signat e d Primary Car e Hospitals or F e d e rally 



C e rtifi e d Primary Car e Hospitals. — The g e neral 



)r modifi e d by tho rul e s of this S e ction. 
'tatutory Authority G.S. 131E-76; 131E-79. 

2102 DEFINITIONS 

Th e following d e finitions shall apply throughout 



his Section, unless t e xt oth e rwis e cl e arly indioatos 
:o tho oontrary: 



Q) "Availabl e " m e ans provided dir e ctly by 

th e hospital or by writt e n agr ee m e nt with 
a qualified provid e r of th e s e rvic e within 
on e hour. 

@) "D e signated — Primary — Cafe — Hospital" 

moans a ho s pital d e signated by th e North 
Carolina Offic e of Rural — Health — and 



Resourc e — D e v e lopm e nt — in — aooordanoo 
with G.S. 13 IE 76(6). 

(3) "F e d e rally — C e rtifi e d — Primary — Gafe 

Hospital" m e ans a hospital whioh has 
boon — de s ignat e d — and — c e rtified — as — a 
Federally C e rtifi e d Rural Primary Care 
Hospital — und e r — tn« — Essential — Aoc e ss 

Community Hospital Program 

administ e r e d through th e North Carolina 
Offic e of Rural H e alth — and — R e sourc e 
Developm e nt in aooordano e with P.L. 
101 239 and P.L. 101 50 8 . 

{4) "Primary Car e Inpatient S e rvic e s" means 

that th e hospital — provid e s — acut e oare 
inpati e nt sorvioos appropriate to th e l e v e l 
ef- — sorvioo — at — the — faoility — up — te — a 
maximum annual av e rag e daily o e nsus of 

15 pati e nts per day. In addition, th e 

hospital may also provide long t e rm care 
in "swing b e d" or distinot part status and 
psyohiatrio distinot part b e d s . 

Statutory Authority G.S. 131E-76; 131E-79. 

.2103 LICENSURE APPLICATION 

An application from a hospital see king to be 
licens e d und e r th e rul e s of thi s S e ction must b e 
aooompani e d — by — written — c e rtification — from — the 
North — Carolina — Offic e — ef- — Rural — Health — and 
R e sourc e — D e v e lopm e nt — that — th« — hospital — is — a 
D e signat e d Primary Care Ho s pital or a F e d e rally 
C e rtified Primary Car e Hospital. 

Statutory Authority G.S. 131E-76; 131E-79. 



.2104 FEDERALLY CERTD7IED PRIMARY 
CARE HOSPITAL 

(a) Th e r e quir e m e nts of 10 NCAC 3C .0300 
through .1699 and .1712(a) shall b e waiv e d for a 
hospital whioh th e North Carolina Offic e of Rural 
H e alth and R e sourc e D e v e lopm e nt c e rtifi e s as a 
d e signat e d — F e d e rally — C e rtified — Primary Caro 
Hospital, and Rul e .170 4 (a) of that Subohapter 
shall not apply to suoh hospitals whioh do not 
provide emergency room s e rvice or maintain any 
lif e support syst e ms. 

{e) — Th e Division r e s e rv e s th e right to oonduot 
any validation survey or investigation of a speoifio 
complaint in hospitals whioh choos e to b e lic e nsed 
as a F e d e rally C e rtifi e d Primary Car e Hospital. 

Statutory Authority G.S. 131E-76; 131E-79. 

.2105 DESIGNATED PRIMARY CARE 
HOSPITALS 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1769 



PROPOSED RULES 



Th e r e quir e m e nts of 10 NCAC 3C ohall apply to 
D e signat e d — Primary — Car e — Hospitals — with — the 
following modifications: 

(4-) Autopsy faoiliti e s r e quir e d in Rul e .070 4 

of this Subchapter ar e not required for a 
D e signat e d — Primary — Gafe — Hospital, 
provid e d that the hospital has in e ff e ot a 
writt e n agre e ment with anoth e r lio e ns e d 
hospital — m ee ting — R«4e — ,070 4 — of this 
Subchapt e r fef providing autopsy 



m- 



&- 



services. 



Radiological s e rvic e s r e quired in Section 
,0800 of this Subchapter ar e not requir e d 
for D e signat e d Primary Car e Hospitals 
provid e d that th e hospital has radiologioal 
equipment — en — site — and — a — writt e n 
agre e m e nt with another lio e ns e d hospital 
m ee ting — the — r e quir e m e nts — ef- — S e ction 
.0800 of this Subchapt e r whioh mak e s 
radiologioal servic e availabl e . 

{3} Em e rg e noy s e rvic e s r e quir e d in S e ction 

. 1000 of this Subchapt e r are not r e quir e d 
for D e signat e d Primary Car e Hospitals. 
Modioal staff of a D e signat e d Primary 
Car e Hospital shall assur e that hospital 
p e rsonn e l — afe — capabl e — ef- — initiating 
lif e saving measures at a first aid level of 
r e spons e for any pati e nt or person in 

n e ed — ef- — sueh — s e rvic e s . T-hk — shall 

inolud e : 
{a) Establishing protoools — or agr ee ments 

with any hospital providing em e rg e noy 

services; 
(e) Initiating — basic oardio r e spiratory 

r e suscitation according to th e Am e rioan 

Red Cross — ef — Am e rioan — Heart 

Association standards; 
{&) Availability of int e r v e inous fluids and 

suppli e s r e quir e d te e stablish 

int e r v e inous aoooss; and 
{d) Availability — ef- — first lin e — e m e rg e noy 

drugs as sp e cifi e d by th e m e dioal staff. 

(4) Anesth e sia s e rvic e s r e quir e d in S e ction 

,1200 of this Subchapter are not required 
in D e signat e d Primary Car e Hospitals not 
off e ring outpati e nt surg e ry servic e s. 



Food 



ired in Seotion .1600 



loo s requ 

of this Subchapter must be provid e d for 
inpati e nts of Designat e d Primary Car e 
Hospitals — e ith e r — dir e ctly — ef — made 
availabl e — through — oontraotual 
arrang e m e nts. 



Statutory Authority G.S. 131E-76; 131E-79. 



SECTIONS .2200 - 2900 - RESERVED 
FOR FUTURE CODIFICATION 

SECTION .3000 - GENERAL 
INFORMATION 

.3001 DEFINITIONS 

The following definitions shall apply throughoi 



this section, unless the text clearly indicates to th 

contrary: 
(1) "Appropriate" means suitable or fittin; 
conforming to standards of care a 
established by professional organizatio 



£21 



£31 



£41 
£51 



£61 



01 



m 



£91 



(10) 



"Approved" means acceptable to th 
authority having jurisdiction. 
"Advanced Practice Nurse" means 
registered nurse with a graduate degre 
or advanced formal education in 
clinical nursing specialty who j 
credentialed by the Board of Nursing o 
the Board of Medical Examiners, Thi 
includes but is not limited to the Certifie 



Registered Nurse Anesthetist (CRNA 
and Certified Nurse Practitioner. 
"Authority having jurisdiction" means th 



Division of Facility Services. 
"Certified Dietary Manager" or "CDM 



means an individual who is certified b 
the Certifying Board of the Dietar 



Managers and meets the standards an 
qualification as referenced in the "Dietar 



Manager Training Progra 



Requirements, " These standards includ 



any subsequent amendments and edition 



of the referenced manual. Copies of th 
"Dietary Manager Training Prograi 



Requirements" may be purchased fo 
fifteen dollars ($15.001 from the Dietar 



Managers Association, One Pierce Place 



Suite 1220W, Itasca, Illinois 60143. 
"Competence" means having th 
predetermined requisite abilities 
qualities to perform specific functions 
"Comprehensive" means coverin 
completely, inclusive. 
"Continuous" means ongoing 
uninterrupted, 24 hours per day. 
"CRNA" means a Certified Registers 



Nurse Anesthetist as credentialed by th 
Council on Certification of Nurs 



Anesthetists, Board of Nursing, or th 
Board of Medical Examiners. 
"Credentialed" means that the individu 



having a given title or position has bee 
credited with the right to exercise officii 



1770 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



power. 

(11) "Department" means the Department of 
Human Resources. 
2} " Departmentalized medical staff" means 
the divisions within the medical staff 
which separate specialties such as 
medicine, surgery. pediatrics, 
orthopedics. 

(13) "Dietetics" means the integration and 
application of principles derived from the 
science of nutrition, biochemistry, 
physiology, food and management and 
from behavioral and social sciences to 
achieve and maintain optimal nutritional 
status. 

(14) "Dietitian" means an individual who is 
licensed according to G.S. 90, Article 
25, or is registered by the Commission 
on Dietetic Registration (CDR) of the 
American Dietetic Association (ADA) 
according to the standards and 
qualifications as referenced in the second 
edition of the "Accreditation/ Approval 
Manual for Dietetic Education 
Programs", "The Registration Eligibility 
A pplication for Dietitians" and the 
"Continuing Professional Education" and 
subsequent amendments or editions of the 
reference material. Copies of the 
"Accreditation/ Approval Manual for 
Dietetic Education Programs" may be 
purchased for twenty-one dollars and 
ninety-five cents ($21.95) plus three 
dollars ($3.00) minimum shi pping and 
handling from ADA Sales Order 
Department. P.O. Box 97215. Chicago. 
IL 60678-7215. 

(15) "Dietetic Technician Registered" or 
"DTR" means an individual who is 
registered by the Commission on Dietetic 
Registration (CDR) of the American 
Dietetic Association (ADA) according to 
the standards and qualifications as 
referenced in the second edition of the 
"Accreditation/ Approval Manual for 
Dietetic Education Programs". The 
Registration Eligibility A pplication for 
Dietetic Technicians" and the 
"Continuing Professional Education". 
Standards include any subsequent 
amendments and editions of the 
referenced material. Copies of the 
"Accreditation/ Approval Manual for 



(16) 

(17) 
(18) 

(19) 
(20) 

(21) 

(22) 
(23) 



(24) 
(25) 



(26) 

(27) 
(28) 

(29) 
(30) 



minimum for shipping and handling from 
the ADA Sales Order Department. P.O. 
Box 97215. Chicago. IL 60678-7215. 
"Direct Supervision" means under the 
immediate management of a supervisor or 
other person of authority. 
"Division" means the Division of Facility 
Services. 



Dietetic Education Programs" may be 
purchased for $21.95 plus $3.00 



"Easily accessible" means the ability to 
enter, a pproach, communicate with or 
pass to and from, or to make use of 
without interference of physical barriers. 
"Facility" means a hospital as defined in 
G.S. 131E-76. 

"Free standing facility" means a facility 
that is physically separated from the 
primary hospital building or separated by 
a three hour fire containment wall. 
"Full-time equivalent" means the method 
used to designate employee status for 
budget purposes; for accounting purposes 
this equals 2080 hours. 
"Governing body" means the authority as 
defined in G.S. 131E-76. 
"Imaging" means a reproduction or 
representation of a body or body part for 
diagnostic purposes by radiologic 
intervention that may include 
conventional fluoroscopic exam, magnetic 
resonance, nuclear or radio-isotope scan. 
"Informed consent" means consent to 
health care treatment as defined in G.S. 
90-21.13. 

"Invasive procedure" means a procedure 
involving puncture or incision of the 
skin, insertion of an instrument or 
foreign material into the body (excluding 
venipuncture and intravenous therapy) . 
"LDRP" (labor, delivery, recovery, post- 
partum) means a specific single 
occupancy obstetrical use room counted 
as a licensed bed. 

"License" means formal permission to 
provide services as granted by the State. 
"Mission statement" means a written 
statement of the philosophy and beliefs of 
the organization or hospital as approved 
by the governing authority. 
"Neonate" means the newborn from birth 
to one month. 

"NP" means a Nurse Practitioner as 
defined in G.S. 90-6: 90-18(14) and 90- 
18.2. 
(31) "Nurse executive" means the director of 
nursing services or a representative of 



.21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1771 



PROPOSED RULES 



(32) 
(33) 
(34) 



(36) 
(37) 
(38) 



(39) 
(40) 
(41) 

(42) 
(43) 
(44) 



decentralized nursing management staff. 
"Nurse midwife" means a Certified Nurse 
Midwife as defined in G.S. 90, Article 
KL 

"Nursing facility" means that portion of 
a hospital that is approved to provide 
skilled nursing care. 

"Nutrition therapy " ranges from 
intervention and counseling on diet 
modification to administration of 
specialized nutrition therapies as 
determined necessary to manage a 
condition or treat illness or injury. 
Specialized nutrition therapies include 
supplementation with medical foods, 
enteral and parenteral nutrition. 
Nutrition therapy integrates information 
from the nutrition assessment with 
information on food and other sources of 
nutrients and meal preparation consistent 
with cultural background and 
socioeconomic status. 



(35) "Observation bed" means a bed used for 
a limited time, generally 24-72 hours, to 
evaluate and determine the condition and 
disposition of a patient and is not 
considered a part of the hospital's 



licensed bed capacity. 
"PA" means a Physician 



Assistant as 



certified by the North Carolina Board of 

Medical Examiners. 

"Patient" means any person admitted to 

the hospital for diagnostic services or 

nursing care. 

"Physical Rehabilitation Services" means 

any combination of physical, 

occupational, speech therapy or 

vocational rehabilitation that meets the 

needs of the patient's served. 

"Provisional license" means a hospital 

license recognizing significantly less than 

full compliance with the licensure rules. 

"Qualification" means the conditions that 

must be complied with have been met (as 

the attainment of a privilege) 

"Qualified" means having complied with 

the specific predetermined conditions for 

employment or the performance of a 

function. 

"Reasonable" means not extreme, 

sensible. 

"Reference" means to use in consultation 

to obtain information. 

"Sound" means free from defect or 

damage; reliable. 



(45) 



"Special Care Unit" means a desi 
unit or area of a hospital with 
concentration of qualified professior 



staff and support services that provi 
intensive or extra ordinary care on a 2 
hour basis to critically ill patients; the 
units may include but are not limited 



Cardiac Care, Medical or Surgk 
Intensive Care Unit, Cardiothorac 



Intensive Care Unit, Burn Intensive Ca 



Unit, Neurologic Intensive Care Unit 
Pediatric Intensive Care Unit. 
(46) "Substantial" means ample to satisfy a 



nourish; real or true; being that specifi 



(47) 
(48) 



to a large degree or in the main. 
"Substantially" means firmly, wi 
strength or to a substantial degree. 
"Unit" means a designated area of t 
hospital for the delivery of patient ca 
services. 



Statutory Authority G.S. 131E-79. 

SECTION .3100 - PROCEDURE 

.3101 GENERAL REQUIREMENTS 

(a) An application for licensure shall 
submitted to the Division prior to a license bei 
issued or patients admitted. 

(b) An existing facility shall not sell, lease 



subdivide a portion of its bed capacity without tl 
approval of the Division. 

(c) Application forms may be obtained 
contacting the Division. 

(d) The Division shall be notified in writii 



prior to the occurrence of any of the following: 
(1) addition or deletion of a licensab 



12} 
13} 
(4} 
£5} 
16} 



service; 

increase or decrease in bed capacity 



change of chief executive officer; 
change of mailing address; 
ownership change; or 
name change. 
(e) Each application shall contain the followii 
information: 

(1) legal identity of applicant; 

(2) name or names under which tl 
hospital or services are presented to tl 
public; 

(3) name of chief executive officer; 

(4) ownership disclosure; 

(5) bed complement; 

(6) bed utilization; 

(7) accreditation data; 

(8) physical plant inspection data; and 



1772 



NORTH CAROLINA REGISTER 



February 1, 1995 



9: 



PROPOSED RULES 



(9) service data. 

tutory Authority G.S. 131E-79. 

02 PLAN APPROVAL 

1} The facility design and construction shall be 
accordance with the construction standards of 



Division, the North Carolina Building Code, 



| local municipal codes. 
3} Submission of Plans: 

(1) Before construction is begun, plans and 
specifications covering construction of 
the new buildings, alterations or 
additions to existing buildings, or any 
change in facilities shall be submitted to 
the Division for approval. 

(2) The Division will review the plans and 
notify the licensee that said buildings, 
alterations, additions, or changes are 
approved or disapproved if plans are 
disapproved the Division shall give the 
applicant notice of deficiencies 
identified by. the Division. 



In order to avoid unnecessary expense 
in changing final plans, a preliminary 
step, proposed plans in schematic form 
shall be reviewed by the Division. 
The plans shall include a plot plan 
showing the size and shape of the entire 
site and the location of all existing and 
proposed facilities. 

Plans shall be submitted in triplicate in 
order that the Division may distribute a 



£3} 



(4) 



(51 



copy to the Department of Insurance for 
review of State Building Code 
requirements and to the Department 
Environmental Health Natural 
Resources for review under state 
sanitation requirements. 
(c) Location: 

(1) The site for new construction or 
expansion shall be a pproved by the 
Division. 

(2) Hospitals shall be so located that they 
are free from undue noise from 
railroads, freight yards, main traffic 



(6) Available paved roads, adequate water, 

sewage and power lines shall be taken 

into consideration in selecting the site. 

(d) The bed capacity and services provided in a 

facility shall be in compliance with G.S. 131E, 

Article 9 regarding Certificate of Need. A facility 

shall be licensed for no more beds than the number 

for which required physical space and other 

required facilities are available. Neonatal Level II 

and HI beds are considered beds for licensure 

purposes, but Level I (bassinets for newborns) are 

not considered part of licensed bed capacity. 

Statutory Authority G.S. 131E-79. 

.3103 CLASSIFICATION OF MEDICAL 
FACILITIES 

(a) The classification of "hospital" shall be 
restricted to facilities that provide as their primary 
functions diagnostic services and medical and 
nursing care in the treatment of acute stages of 
illness. On the basis of specialized facilities and 
services available, the Division shall license each 
such hospital according to the following medical 
types: 

(1) general acute care hospital; 

(2) rehabilitation hospital; 

(3) designated primary care hospital; or 

(4) federally certified primary care 
hospital. 

(b) All other inpatient medical facilities 
accepting patients requiring skilled nursing 
services but which are not operated as a part of 
any hospital within the above meaning shall be 
considered to be operating as a nursing home and, 
therefore, are not subject to hospital licensure. 

Statutory Authority G.S. 131E-79. 

.3104 LENGTH OF LICENSE 

Licenses shall remain in effect for an indefinite 
period of time, unless the following occurs: 
(1) Division im poses an administrative 
sanction which specifies license 



(21 



expiration; 

change of ownership; 





arteries. schools and children's 


(3) closure; 




playgrounds. 


(4) change of site; 


m 


The site shall not be exposed to smoke. 


(5) failure to comply with Rule .3105 of this 




foul odors, or dust from nearby 


Section. 




industrial plants. 




(Jl 


The area of the site shall be sufficient 
to permit future expansion and to 


Statutory Authority G.S. 131E-79. 




provide adequate parking facilities. 


.3105 STATISTICAL INFORMATION 


(51 


The site shall be easily accessible. 


Utilization data shall be submitted annually upon 


.21 


NORTH CAROLINA REGISTER 


February 1, 1995 1773 



PROPOSED RULES 



request by the Division. Forms for collection of 
this data will be forward to each facility by the 
Division. 

Statutory Authority G.S. 131E-79. 

.3106 LICENSURE SURVEYS 

(a) Prior to the initial issuance of a license to 
operate a facility, the Division shall conduct a 
survey to determine compliance with rules 
promulgated pursuant to G.S. 131E-79. 

(b) The Division may conduct an investigation 
of a specific complaint in any facility. 

(c) Facilities that are accredited by. the Joint 
Commission on Accreditation of Healthcare 
Organizations (JCAHO) shall choose one of the 
following options: 

(1) Accredited hospitals may agree to 
provide the Division with: 

(A) JCAHO Accreditation Certificate: 

(B) JCAHO Statement of Construction: 

(C) JCAHO Reports and 
Recommendations: 

(D) JCAHO Interim Self-Survey Reports; 
and 

(E) permission to participate in any 
regular survey conducted by the 
JCAHO. 

If a review of the information listed in 
Subparagraphs (c)(1)(A) : (c)(1)(D) 
indicates non-compliance with licensure 
rules contained in this Subchapter, then 
the Division may conduct surveys or 
partial surveys with special emphasis on 
deficiencies noted. If a review 
indicates compliance with licensure 
regulations contained in this 
Subchapter, the Division will not 
conduct a licensure survey except as 
provided in Paragraphs fb), (c)(1)(E), 
and (d) of this Rule. 

(2) Accredited hospitals which do not agree 
to provide the Division with JCAHO 
reports found in (c)(1) of this Rule shall 
be surveyed at least once every three 
years. 

(d) The Division reserves the right to conduct 
any validation survey in facilities that choose the 
option under Subparagraph (c)(1) of this Rule. 

(e) The Division shall survey non-accredited 
facilities at least once every three years. 

Statutory Authority G.S. 131E-79. 

.3107 DENIAL, AMENDMENT OR 



REVOCATION OF LICENSE 

(a) The Department may deny any licensu 



a pplication upon becoming aware that the applica 



is not in compliance with any applicable provisk 



of the Certificate of Need law located in G. 
131E, Article 9 and the rules adopted under th 
law. 

fb) The Department may amend a license 1 
reducing it from a full license to a provision 



license whenever the Department finds that: 

(1) the licensee has failed to comply wi 

the provisions of G.S. 131E. Article 



and the rules promulgated under th 

article; 

(2) there is a probability that the license 



can remedy the licensure deficiencii 



within a length of time not to excee 



£3} 



the expiration date on the license: and 
there is a probability that the license 



will be able thereafter to remain i 
compliance with the hospital licensui 
rules for the foreseeable future. 



(c) The Department shall also amend a license t 
provisional status by specifically prohibiting 
licensee from providing certain services, for whi 



it has been found to be out of compliance wit 
G.S. 131E, Articles 5 or 9. In all cases th 
Department shall give the licensee written notic 



of the amendment of the license. This notice sha 



be given by registered or certified mail or b 
personal service and shall set forth: 

(1) the length of the provisional license; 
the factual allegations; 



121 
£21 

£41 



the statutes and rules alleged to b 
violated; and 

notice of the facility's right to 
contested case hearing on th 
amendment of the license. 
(d) The provisional license shall be effectiv 



immediately upon its receipt by the licensee an 
shall be posted in a prominent location, accessibl 



to public view, within the licensed premises in lie 
of the full license. The provisional license sha 
remain in effect until: 

(1) the Department restores the licensee t< 
full licensure status; 

(2) the Department revokes the licensee' 
license; or 

(3) the end of the licensee's licensun 
period. 

If a licensee has a provisional license at the tim< 
that the licensee submits a renewal application, the 
license, if renewed, shall also be a provisions 



license unless the Department determines that thj 
licensee can be returned to full licensure status. A 



1774 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



decision to issue a provisional license is stayed 
during the pendency of an administrative appeal 
and the licensee may continue to display its full 
license during the a ppeal. 

(e) The Department shall revoke a license 
whenever: 

(1) The Department finds that: 

(A) the licensee has failed to comply with 
the provisions of G.S. 131E, Article 
5 and the rules promulgated under 
that article: and 

£B) it is not probable that the licensee can 
remedy the licensure deficiencies 
within a length of time acceptable to 
the Department: or 

(2) The Department finds that: 

(A) The licensee has failed to comply with 
the provisions of Ci S^ 131E, Article 
5; and 

(B) although the licensee may be able to 
remedy the deficiencies within a 
reasonable time, it is not probable that 
the licensee will be able to remain in 
compliance with hospital licensure 
rules for the foreseeable future; or 

(3) The Department finds that the licensee 
has failed to comply with any of the 
provisions of G.S. 131E. Article 5 and 
the rules promulgated thereunder that 
endangers the health, safety or welfare 
of the patients in the facility. 

The issuance of a provisional license is not a 
procedural prerequisite to the revocation of a 
license pursuant to Subparagraphs (d)(1). (2) or (3) 
of this Rule. 

Statutory Authority G.S. 131E-79. 

.3108 SUSPENSION OF ADMISSIONS 

(a) The Department may suspend the admission 
of any new patient to any facility when warranted 
under the provisions of G.S. 131E-78. 

(b) The Department shall notify the facility by. 
registered or certified mail or by personal service 
of the decision to suspend admissions. Such notice 
will include: 

(1) the period of the suspension: 

(2) factual allegations: 

(3) citation of statutes and rules alleged to 
be violated; and 

(4) notice of the facility's right to a 
contested case hearing. 

(c) The suspension shall be effective when the 
notice is served or on the date specified in the 
notice of suspension, whichever is later. The 



suspension shall remain effective for the period 
specified in the notice or until the facility 
demonstrates to the Department that conditions are 
no longer detrimental to the health and safety of 
the patient. 

(d) The facility shall not admit new patients 
during the effective period of the suspension. 

Statutory Authority G.S. 131E-79. 

.3109 PROCEDURE FOR APPEAL 

A facility may a ppeal any decision of the 
Department to deny, revoke or amend a license or 
any decision to suspend admissions by making 
such an appeal in accordance with G.S. 15QB. 

Statutory Authority G.S. 131E-79. 

.3110 ITEMIZED CHARGES 

(a) The facility shall either present an itemized 
list of charges to all discharged patients upon 
request or the facility shall include on patients' 
bills, which are not itemized, notification of the 
right to request an itemized bill within 30 days of 
receipt of the non-itemized bill. 

(b) If requested, the facility shall present an 
itemized list of charges to each patient, or his 
responsible party. 

(c) The itemized listing shall include, at a 
minimum, those charges incurred in the following 
service areas: 

(1) room rates; 

(2) laboratory; 

(3) radiology and nuclear medicine; 

(4) surgery; 

(5) anesthesiology; 

(6) pharmacy; 

(7) emergency services; 

(8) outpatient services; 

(9) specialized care; 

(10) extended care; 

(11) prosthetic and orthopedic a ppliances; 
and 

(12) other professional services. 

Statutory Authority G.S. 131E-79. 

SECTION .3200 - GENERAL 
HOSPITAL REQUIREMENTS 

.3201 HOSPITAL REQUIREMENTS 

A facility shall have all of the following: 

(1) an organized governing body; 

(2) a chief executive officer; 

(3) an organized medical staff; 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1775 



PROPOSED RULES 



(4) 

£5} 
16} 

{§} 

£9} 
(a) 

£b] 



id} 



m 

(si 

mi 
m 

(10) 

iaj 

mi 



Id} 

M 
(f) 

mi 
mi 



Hi 



mi 



an organized nursing staff; 

continuous medical services; 

continuous nursing services; 

permanent on-site facilities for the care of 

patients 24 hours a day; 

a hospital-wide infection control 

program; 

minimum on-site clinical provisions as 

follows: 

appropriately equipped inpatient care 

areas; 

nursing care units; 

diagnostic and treatment areas to 

include on-site laboratory and imaging 

facilities with the capacity to provide 

immediate response to patient 

emergencies; 

pharmaceutical services in compliance 

with the Pharmacy Laws of North 

Carolina; 

facilities to assure the sterilization of 

equipment and supplies; 

medical records services; 

provision for social work services; 

current reference sources to meet staff 

needs; and 

nutrition services, 
minimum supportive 



capabilities or 



facilities as follows: 
nutrition and dietetic services; 
scheduled general and preventive 
maintenance services for building, 
services and biomedical equipment; 
capability for obtaining police and fire 
protection, emergency transportation, 
grounds-keeping, and snow removal; 
personnel recruitment, training and 
continuing education; 
business management capability; 
short and long-range planning 
capability; 

financial plan to assure continuity of 
operation under both normal and 
emergency conditions; 
comprehensive policies and standards 
for assuring the safety of patients, 
employees, and visitors and for 
protection against malpractice and 
negligence; and 

comprehensive policies assuring that 
preventive and corrective maintenance 
is performed including procedures to be 
followed in the event of a breakdown of 
essential equipment. 

facilities must comply with construction 



(12) 
(§} 



mi 



mi 



id} 
03} 

mi 
mi 



mi 



rules in Sections .6000- .6200 of t 

Subchapter. 

a risk management program as follows 
a specific staff member shall 
assigned responsibility for developmi 



and administration of the program: 
a written policy statement evidencing 
current commitment to the 
management program together w 
written procedures, policies a 
educational programs applicable to 
risk management program which 
reviewed at least every three years a 
updated as necessary; 
established lines of communicati 



between the risk management progn 



and other functions relating to qual 
of patient care, safety, and professioi 
staff performance; and 
a written report of the activities of t 
risk management program shall 
annually submitted to the governi 
body. 
a quality assessment and improveme 



program which provides: 
continuous assessment and evaluation 



patient care and related services in 

services and departments; 

a designated individual to coordina 



the quality assessment and improveme 



program who will assist in tl 
establishment of quality assessment ai 
improvement plans and reportii 
methods for each service ai 
department; 

a committee made up of representativ' 
of the medical and nursing stal 
administration, and other services < 
departments as defined by the hospit 



to coordinate the program, meet at lea 
quarterly and maintain minutes of tl 
meetings and committee activities; an' 
(d) for each service and department < 
defined by the hospital to be involve 
in the continuous assessmen 



monitoring and evaluation of patiei 
care and related services. 

Statutory Authority G.S. 131E-79. 

.3202 ADMISSION AND DISCHARGE 

(a) Facility management shall provide writte 



admission and discharge, and referral policies. 

(b) There shal l be on the premises at all time 
an employee authorized to receive patients and to 



1776 



NORTH CAROLINA REGISTER 



February I, 1995 



9:2. 



PROPOSED RULES 



make administrative decisions on their disposition. 

(c) A patient shall be admitted only under the 
care of a member of the medical staff meeting the 
provisions of Rule .4302 of this Subchapter. 

(d) Facility management shall ensure that 
precautions are taken to ensure the safety and legal 
rights of all patients and employees. 

(e) Facility management shall ensure that a 
complete and permanent record is maintained for 
all outpatients and inpatients including the date and 
time of admission and discharge. Effort shall be 
made to verify the full and true name, address, 
date of birth, nearest of kin, provisional diagnosis, 
condition on admission and discharge, referring 
physicians, attending physician or service. 

{fj Facility staff shall provide at the time of 
admission an identification bracelet, band, or other 
suitable device for positive identification of each 
patient. 

(g) No mentally competent adult shall be 
detained by the facility against his will, nor shall 
a child be detained against the will of a parent or 
legal guardian. This restriction shall not a pply to 
persuasion of the patient in his own interest to 
consider the possible consequences of his action, 
nor to the temporary detention of a mentally 
disturbed patient for the protection of himself and 
others, pending prompt legal disposition as may be 
provided for in G.S. 122C. Documentation of the 
commitment process shall be retained for all 
involuntary commitments in accordance with the 
provisions of Rule .4503 of this Subchapter. 

Statutory Authority G.S. 131E-79. 

.3203 DISCHARGE PLANNING 

(a) Facility management shall ensure that 
discharge planning is an integral part of in-patient 
hospitalization. 

(b) Facility management shall have written 
policies and procedures governing discharge 
planning. These shall include but need not be 
limited to the following: 

(1) a ppropriate screening to determine the 
need for discharge planning; 

(2) methods to facilitate the provision of 
follow-up care; 

(3) information to be given to the patient or 
his family or other persons involved in 
caring for the patient on matters such as 
the patient's condition; his health care 
needs; the amount of activity he should 
engage in; any necessary medical 
regimens including drugs, nutrition 
therapy, appointments or other forms of 



therapy; sources of additional hel p from 
other agencies; and procedures to 
follow in case of complications: and 
(4) procedures for assisting the patient and 
his family in gaining information 
regarding financial assistance in paying 
bills incurred as a result of the 
hospitalization, including how to 
receive assistance from the various 
federal and State government programs. 

Statutory Authority G.S. 131E-79. 

.3204 TRANSFER AGREEMENT 

(a) Any facility which does not provide hospital 
based nursing facility service shall maintain written 
agreements with institutions offering this kind of 
care. Such agreements shall provide for the 
transfer and admission of patients who no longer 
require the services of the hospital but do require 
nursing facility services. 

(b) A patient shall not be transferred to another 
medical care facility unless prior arrangements for 
admission have been made. Clinical records of 
sufficient content to insure continuity of care shall 
accompany the patient. 

Statutory Authority G.S. 131E-79. 

.3205 DISCHARGE OF MINOR OR 
INCOMPETENT 

Any individual who cannot legally consent to his 
own care shall be discharged only to the custody 
of parents, legal guardian, person standing in loco 
parentis, or another responsible party unless 
otherwise directed by the parent or guardian or 
court of competent jurisdiction. If the parent or 
guardian directs that discharge be made otherwise, 
he shall so state in writing, and the statement shall 
become a part of the permanent medical record of 
the patient. 

Statutory Authority G.S. 131E-79. 

SECTION .3300 - PATIENT'S 
BILL OF RIGHTS 



.3301 PREVCD7LE 

It is the purpose of 



these requirements to 



promote the interests and well-being of the patients 
in facilities subject to this Subchapter even in those 
instances where the interests of the patients may be 
in o pposition to the interests of the facility. The 
facility has the right to expect the patient to fulfill 
patient responsibilities as may be stated in the 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1777 



PROPOSED RULES 



facilities 1 policies affecting patient care and 
conduct. 

Statutory Authority G.S. 131E-79. 

.3302 MINIMUM PROVISIONS OF 
PATIENT'S BILL OF RIGHTS 

(a) A patient has the right to respectful care 
given by competent personnel. 

(b) A patient has the right, upon request, to be 
given the name of his attending physician, the 
names of a]J other physicians directly participating 
in his care, and the names and functions of other 
health care persons having direct contact with the 
patient. 

(c) A patient has the right to every consideration 
of his privacy concerning his own medical care 
program. Case discussion, consultation, 
examination, and treatment are considered 
confidential and should be conducted discreetly. 

(d) A patient has the right to have all records 
pertaining to his medical care treated as 
confidential except as otherwise provided by law 
or third party contractual arrangements. 

(e) A patient has the right to know what facility 
rules and regulations apply to his conduct as a 
patient. 

(f) The patient has the right to expect emergency 
procedures to be implemented without unnecessary 
delay. 

(g) The patient has the right to good quality care 
and high professional standards that are continually 
maintained and reviewed. 

(n) The patient has the right to ful] information 
in laymen's terms, concerning his diagnosis, 
treatment and prognosis, including information 
about alternative treatments and possible 
complications. When it is not possible or medical- 
ly_ advisable to give such information to the 
patient, the information shall be given on his 
behalf to the patient's next of kin or other appro- 
priate person. 

(i) Except for emergencies, the physician must 
obtain the necessary informed consent prior to the 
start of any procedure or treatment, or both. 

(j) A patient has the right to be advised when a 
physician is considering the patient as a part of a 
medical care research program or donor program. 
Informed consent must be obtained prior to actual 
participation in such program and the patient or 
legally responsible party, may, at any time, refuse 
to continue in any such program to which he has 
previously given informed consent. 

(k) A patient has the right to refuse any drugs, 
treatment or procedure offered by the facility, to 



the extent permitted by law, and a physician shal 
inform the patient of his right to refuse any drugs 
treatment or procedures and of the medica 
consequences of the patient's refusal of any drugs 
treatment or procedure. 

£1} A patient has the right to assistance ii 
obtaining consultation with another physician at thi 
patient's request and expense. 

(m) A patient has the right to medical anc 
nursing services without discrimination based upo 
race, color, religion, sex, sexual preference 



national origin or source of payment. 

(n) A patient who does not speak English shal 
have access, when possible, to an interpreter- 
Co) The facility shall provide the patient, o 
patient designee, upon request, access to al 
information contained in his medical records 
unless access is specifically restricted by th< 
attending physician. If the physician restricts th 
patients access to information in his medic a 



record, the physician shall record the reasons 01 
the patient's medical record. Access shall b 
restricted only for sound medical reason. 
(p) The patient has the right to expec 



management techniques to be implemented withii 



the facility considering effective use of the time o 



the patient and to avoid the personal discomfort o 
the patient. 

(q) When medically permissible, a patient ma; 
be transferred to another facility only after he o 
his next of kin or other legally responsibl 



representative has received complete informatior 



and an explanation concerning the needs for anc 
alternatives to such a transfer. The facility tc 
which the patient is to be transferred must firs 
have accepted the patient for transfer- 
er) The patient has the right to examine anc 
receive a detailed explanation of his bill. 

(s) The patient has a right to full informatioi 
and counseling on the availability of knowi 
financial resources for his health care. 

(tj A patient has the right to expect that the 
facility will provide a mechanism whereby he i 
informed upon discharge of his continuing healtl 



care requirements following discharge and th? 
means for meeting them. 

(u) A patient cannot be denied the right a 
access to an individual or agency who i: 
authorized to act on his behalf to assert or protec 
the rights set out in this Section. 

(v) A patient has the right to be informed of hjj 
rights at the earliest possible time in the course o 
his hospitalization. 

Statutory Authority G.S. 131E-79. 



1778 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



.3303 PROCEDURE 

{a} Facility management shall develop and 
im plement procedures to inform each patient of his 
rights. Copies of the facilities' Patient's Bill of 
Rights shall be made available through one of the 
following ways: 

(1) prominent displays in appropriate 
locations in addition to copies available 
upon request; or 

(2) provision of a copy to each patient or 
responsible party upon admission or as 
soon after admission as is feasible. 

(b) The address and telephone number of the 
section in the Department responsible for the 
enforcement of the provisions of this part shall be 
posted. 

(c) Facility management shall adopt procedures 
to ensure effective and fair investigation of 
violations of patients' rights and to ensure their 
enforcement. These procedures shall ensure that: 

(1) a system is established to identify 
formal written complaints; 

(2) formal written complaints are recorded 
and investigated; 

(3) investigation and resolution of formal 
complaints shall be conducted; and 

{4} disciplinary and education procedures 
shall be developed for members of the 
hospital and medical staff who 
consistently cause patient relationship 
problems. 

(d) The Division shall investigate or refer to 
a ppropriate State agencies all complaints within the 
jurisdiction of the rules in this Subchapter. 

Statutory Authority G.S. 131E-79. 

SECTION .3400 - SUPPLEMENTAL 

RULES FOR THE LICENSURE 

OF DESIGNATED PRIMARY CARE 

HOSPITALS AND FEDERALLY 

CERTHTED PRIMARY CARE HOSPITALS 

.3401 SUPPLEMENTAL RULES 

The rules of this Section pertain only to 
designated Primary Care Hospitals or Federally 
Certified Primary Care Hospitals. The general 
requirements of this Subchapter shall apply to such 
facilities except where they are specifically waived 
or modified by the rules of this Section. 

Statutory Authority G.S. 131E-79. 

.3402 DEFINITIONS 

The following definitions shall app ly throughout 



this Section, unless text otherwise clearly indicates 
to the contrary: 

(1) "Available" means provided directly by 
the facility or by. written agreement with 
a qualified provider of the service within 
one hour. 

(2) "Designated Primary Care Hospital" 
means a facility designated by the North 
Carolina Office of Rural Health and 
Resource Development in accordance 
with G.S. 131E-76(61. 

(3) "Federally Certified Primary Care 
Hospital" means a hospital which has 
been designated and certified as a 
Federally Certified Rural Primary Care 
Hospital under the Essential Access 
Community Hospital Program 
administered through the North Carolina 
Office of Rural Health and Resource 
Development in accordance with PL. 
101-239 and P.L. 101-508. 

(4) "Primary Care Inpatient Services" means 
that the hospital provides acute care 
inpatient services a ppropriate to the level 
of service at the facility up to a 
maximum annual average daily census of 
15 patients per day. In addition, the 
facility may also provide long term care 
in "swing bed" or distinct part status and 
psychiatric distinct part beds. 

Statutory Authority G.S. 131E-79. 

.3403 LICENSURE APPLICATION 

An application from a facility seeking to be 
licensed under the rules of this Section must be 
accompanied by written certification from the 
North Carolina Office of Rural Health and 
Resource Development that the facility is a 
Designated Primary Care Hospital or a Federally 
Certified Primary Care Hospital. 

Statutory Authority G.S. 131E-79. 

.3404 FEDERALLY CERTHTED 

PRIMARY CARE HOSPITAL 

(a} The requirements of K) NCAC 3C .3500 
through .5206 shall be waived for a facility which 
the North Carolina Office of Rural Health and 
Resource Development certified as a designated 
Federally Certified Primary Care Hospital, and 
Rule .6227 (f) and (g) of that Subchapter shall not 
apply to such facilities which do not provide 
emergency room service or maintain any life 
su pport systems. 



9:21 



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February 1, 1995 



1779 



PROPOSED RULES 



(b) The Division reserves the right to conduct 
any validation survey or investigation of a specific 
complaint in facilities which choose to be licensed 
as a Federally Certified Primary Care Hospital. 

Statutory Authority G.S. 131E-79. 

.3405 DESIGNATED PRIMARY CARE 
HOSPITALS 

The requirements of K) NCAC 3C shall apply to 
Designated Primary Care Hospitals with the 
following modifications: 

(1) Autopsy facilities required in Rule .4907 
of this Subchapter are not required for a 
Designated Primary Care Hospital, 
provided that the facility has in effect a 
written agreement with another facility 
meeting Rule .4907 of this Subchapter 
for providing autopsy services. 

(2) Radiological services required in Section 
.4800 of this Subchapter are not required 
for Designated Primary Care Hospitals 
provided that the facility has radiological 
equipment on site and a written 
agreement with another licensed facility 
meeting the requirements of Section 
.4800 of this Subchapter which makes 
radiological service available. 
Emergency services required in Section 
.4100 of this Subchapter are not required 
for Designated Primary Care Hospitals. 
Medical staff of a Designated Primary 
Care Hospital shall assure that facility 
personnel are capable of initiating life- 
saving measures at a first-aid level of 
response for any patient or person in 
need of such services. This shall 
include: 

Establishing protocols or agreements 

with any facility providing emergency 

services; 

Initiating basic cardio -respiratory 

resuscitation according to the American 

Red Cross or American Heart 

Association standards: 



ill 



lei 

id) 

14) 

£5} 



Availability of intravenous fluids and 
supplies required to establish 
intravenous access; and 
Availability of first-line emergency 
drugs as specified by the medical staff. 
Anesthesia services required in Section 
.4600 of this Subchapter are not required 
in Designated Primary Care Hospitals not 
offering outpatient surgery services. 
Food services required in Section .4700 



of this Subchapter shall be provided foi 
inpatients of Designated Primary Can 
Hospitals either directly or mad; 
available through contractus 
arrangements. 

Statutory Authority G.S. 131E-79. 

SECTION .3500 - GOVERNANCE 
AND MANAGEMENT 

.3501 GOVERNING BODY 

(a) The governing body, owner or the person o 
persons designated by the owner as the governin 



authority shall be responsible for seeing that th 
objectives specified in the charter (or resolution i 
publicly owned) are attained. 

fb] The governing body shall be the fina 
authority in the facility to which the administratoi 



the medical staff, the personnel and all auxiliar 



organizations are directly or indirectly responsibl 

(c) A local advisory board shall be establishet 

if the facility is owned or controlled by a 

organization or persons outside of North Carolina 



Statutory Authority G.S. 131E-79. 

.3502 BYLAWS 

(a) The governing body shall adopt bylaws i 
accordance with all requirements contained in thi 
subchapter and in accordance with the communit 



responsibility of the facility. As a minimum, th 
bylaws shall do the following: 

(1) state the general and specific goals o 
the facility; 



£21 



describe the powers and duties of th 
governing body officers and committee 



and the responsibilities of the chie 
executive officer; 
(3) state the qualifications for governin 



£4) 



body membership, the procedures fo 
selecting members, and the terms o 
service for members, officers an 
committee chairmen; 
describe the authority delegated to th 
chief executive officer and to th 
medical staff. No assignment, referral 



15) 



or delegation of authority by th 
governing body shall relieve th 
governing body of its responsibility fo 
the conduct of the facility. Th 
governing body shall retain the right t 
rescind any such delegation; 
require Board approval of the bylaws c 



any auxiliary organizations establishe 



1780 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2. 



PROPOSED RULES 



by the hospital; 

(6) require the governing body to review 
and a pprove the bylaws of the medical 
staff organization; 

(7) establish a procedure for processing and 
evaluating the applications for medical 
staff membership and for the granting 
of clinical privileges; 

(8) establish a procedure for implementing, 
disseminating, and enforcing a Patient's 
Bill of Rights in compliance with G.S. 
131E-117;and 

(9) require the governing body to institute 
procedures to ensure: 

(A) orientation of newly elected board 
members to specific board functions 
and procedures; 

(B) the development of procedures for 
periodic reexamination of the 
relationship of the board to the total 
facility community; and 

(C) the recording of minutes of all 
governing body and executive 
committee meetings and the 
dissemination of those minutes, or 
summaries thereof, on a regular basis 
to all members of the governing body. 

fb) The bylaws shall be reviewed at least every 
three years, revised as necessary, and dated to 
indicate when last reviewed or revised. 

Statutory Authority G.S. 131E-79. 

.3503 FUNCTIONS 

The governing body, with technical assistance 
and advice from the facility staff, shall be 
responsible for the following: 

(1) provide management, physical resources 
and personnel required to meet the needs 
of the patients for which it is licensed; 

(2) require management to establish a quality 
control mechanism which includes as an 
integral part a risk management 
component and an infection control 
program; 

(3) formulate short-range and long-range 
plans for the development of the facility; 

(4) conform to all a pplicable federal. State 
and local laws and regulations; 

(5) provide for the control and use of the 
physical and financial resources of the 
facility; 

(6) review the annual audit, budget and 
periodic reports of the financial 
operations of the facility; 



(7) utilize the advice of the medical staff in 
granting and defining the scope of 
clinical privileges to individuals. When 
the governing body does not concur in 
the medical staff recommendation 
regarding the clinical privileges of an 
individual, there shall be a review of the 
recommendation by a joint committee of 
the medical staff and governing body 
before a final decision is reached by the 
governing body: 

(8) require that applicants be informed of the 
disposition of their application for 
medical staff membership or clinical 
privileges, or both, within an established 
period of time after their application has 
been submitted; 

(9) review and approve the medical staff by- 
laws, rules and regulations body; 

(10) delegate to the medical staff the authority 
to evaluate the professional competence 
of staff members and applicants for staff 
privileges and hold the medical staff 
responsible for recommending initial staff 
appointments, reappointments and 
assignments or curtailments of privileges; 

(11) require that resources be made available 
to address the emotional and spiritual 
needs of patients either directly or 
through referral or arrangement with 
community agencies; 

(12) maintain effective communication with 
the medical staff which shall be 
established, through: 

(a) meetings with the Executive Committee 
of the Medical Staff; 

(b) service by the president of the medical 
staff as a member of the governing 
body with or without a vote; 

(c) appointment of individual medical staff 
members to governing body 
committees; and 

(d) a joint conference committee. 

(13) require the medical staff to establish 
controls that are designed to ensure 
standards of ethical professional 
practices; 

(14) ensure that the medical staff is provided 
with the necessary staff su pport to 
facilitate utilization review and infection 
control within the facility and to su pport 
quality control, any other medical staff 
functions required by this subchapter or 
by the facility bylaws: 

(15) ensure that the following public 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1781 



PROPOSED RULES 



la} 

mi 

M 

iii) 

ib) 

(17) 



(18) 



(19) 



(20) 



(21) 

la) 



1M 



disclosure requirements are being met: 
data required by the North Carolina 
Medical Data Base Commission and the 
Division; 

the facilities' average daily inpatient 
charge upon request; and 
public disclosure of the persons owning 
5.0 percent or more of the facility as 
well as the facilities officers and 
members of the governing body- 
establish a procedure for reporting the 
occurrence and disposition of any unusual 
incidents which will assure that: 

are analyzed and 



incident reports 
summarized; and 

corrective action is taken as indicated 
by the analysis of incident reports; 
in a facility with one or more units, or 
portions of units, however described, 
utilized for psychiatric or substance abuse 
treatment adopt policies implementing the 
provisions of G.S, 122C, Article 3^ and 
Article 5, Parts, 2, 3, 4, 5, 7, and 8; 
develop arrangements for the provision of 
extended care and other long-term 
healthcare services. Such services shall 
be provided in the facility or by outside 
resources through a transfer agreement or 
referrals; 

provide and implement a written plan for 
the care or for the referral, or for both, 
of patients who require mental health or 
substance abuse services while in the 
hospital; 

develop a conflict of interest policy 

which shall apply to all governing body 

members and corporate officers. All 

governing body members shall execute a 

conflict of interest statement; 

ensure members of the governing body 

shall not engage in the following forms 

of self-dealing: 

the sale, exchange or leasing of 

property of services between the facility 

and a governing board member, his 

employer or an organization 

substantially controlled by him on a 

basis less favorable to the facility than 

that on which such property or service 

is made available to the general public; 

furnishing of goods, services or 

facilities by a facility to a governing 

board member, unless such furnishing 

is made on a basis not more favorable 

than that on which such goods. 



i£] 



services, or facilities are made available 
to the general public or employees 
the facility; or 
any transfer to or use by or for thj 
benefit of a governing board member o 
the income or assets of a facility 



(22) 



except by. purchase for fair marke 

value; and 
prohibit the lease, sale, or exclusive ust 
of any facility buildings or facilitiei 



receiving a license in accordance wit! 



this subchapter to any entity whicl 
provides medical or other health service; 



to the facility's patients, unless there ii 
full, complete disclosure to and approva 
from the Division. 

Statutory Authority G.S. 131E-79. 

SECTION .3600 - MANAGEMENT 
AND ADMINISTRATION OF OPERATIONS 



.3601 

The 
executive officer whose qualifications, authority 



CHIEF EXECUTIVE OFFICER 

governing body shall designate a chie 



responsibilities and duties shall be defined in < 
written statement adopted by the governing body. 



Statutory Authority G.S. 131E-79. 

.3602 RESPONSIBILITIES 

(a) The chief executive officer shall be th_ 
designated representative of the governing body. 

(b) The chief executive officer shall: 

(1) designate an individual to act for him ii 
his absence; 



12} 



£3} 



manage the facility commensurate wit! 
the authority conferred on him by thj 
governing body and consonant with it 
expressed aims and policies; 
attend meetings of the governing bod 



and appropriate meetings of the medica 



staff; 

(4) implementation of policies adopted b; 
the governing body for the operation 
the facility; 

organize the administrative functions 
the facility, delegate duties an( 
establish formal means of accountability 



151 



16} 



on the part of subordinates; 
establish such facility departments a 
are indicated, provide for departments 



and interdepartmental meetings am 
attend or be represented at sue] 
meetings, and appoint hospital depart 



1782 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



mental representatives to medical staff 
committees where appropriate or when 
requested to do so by the medical staff; 

(7) appoint the heads of administrative 
departments; 

(8) repo rt to the governing body and to the 
medical staff on the overall activities of 
the facility as well as on appropriate 
federal. State and local developments 
that affect health care in the facility; 

(9) review the annual audit of the financial 
operations of the facility and acting 
upon recommendations therein; 

(10) provide fiscal planning and financial 
management of the facility including the 
provision of annual budgets and 
periodic financial status reports to the 
governing board; 

(11) develop in cooperation with the 
departmental heads and other 
appropriate staff. an overall 
organizational plan for the facility 
which will coordinate the functions, 
services and departments of the facility, 
when possible; and 

(12) ensure that the agreements with service 
providers, such as laundry, laboratory 
and imaging, specifically indicate that 
compliance will be maintained with 
applicable State rules as would apply to 
the same services if provided directly 
by the facility. 

Statutory Authority G.S. 131E-79. 



.3603 PERSONNEL POLICIES AND 
PRACTICES 

The chief executive officer shall ensure 



that 



personnel policies and practices which support 
sound patient care are established and maintained. 
The policies shall be in writing and made available 
to all employees, and they shall be reviewed 
periodically but no less often than once every three 
years. The date of the most recent review shall be 
indicated on the written policies. A procedure 
shall be established for notifying employees of 



changes in the established personnel policies. 
Statutory Authority G.S. 131E-79. 

.3604 JOB DESCRIPTIONS 

Facility management shall ensure that a written 
job description for each type of job ]n the facility, 
including the chief executive officer and heads of 
departments, is developed and made available to 



the employee. 

Statutory Authority G.S. 131E-79. 

.3605 PERSONNEL RECORDS 

(a) Facility management shall maintain accurate 
and complete personnel records for each facility 
employee during his term of employment and for 
two years thereafter. The chief executive officer 
may designate an individual to carry out this 
assignment. 

(b) Personnel records shall contain at least the 
following: 

(1) information regarding the employee's 
education, training and experience, 
including, if applicable, professional 
licensure status and license number, 
sufficient to verify the employee's 
qualifications for the job for which he 
is employed. Such information shall be 
kept current. Applicants for positions 
requiring a licensed person shall be 
hired only after obtaining verification of 
their licenses from the appropriate 
board; 

(2) current information relative to periodic 
work performance evaluations; 

(3) records of such pre-employment health 
examinations and of subsequent health 
services rendered to the employees as 
are necessary to ensure that all facility 
employees are physically able to 
perform their duties; and 

(4) reports verifying that reasonable 
precautions have been taken to ensure 
the absence of detectable active 
communicable disease as defined by the 
North Carolina Department of 
Environment, Health and Natural 
Resources. 

Statutory Authority G.S. 131E-79. 

.3606 EDUCATION PROGRAMS 

Facility management shall provide new employee 
orientation and continuing education programs for 
all employees to maintain the skills necessary for 
the performance of their duties and learn new 
developments in health care. Records shall be 
maintained of all orientation and educational 
programs, and of the participants. 

Statutory Authority G.S. 131E-79. 

.3607 PERSONNEL HEALTH 



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February 1, 1995 



1783 



PROPOSED RULES 



REQUIREMENTS 

Employees shall have pre-employment medical 
examinations and interim examinations in 
accordance with medically acceptable criteria. 

Statutory Authority G.S. 131E-79. 



.3608 

The 

insurance program 



INSURANCE 

governing board 



shall have in place an 
which provides for the 



protection of the physical and financial resources 
of the facility. There shall be appropriate cover- 
age of the building and equipment and adequate 
comprehensive liability insurance or an equivalent 
self-insurance plan covering members of the 
governing board and appropriate medical and 
administrative personnel. 

Statutory Authority G.S. 131E-79. 

.3609 AUDIT OF FINANCIAL OPERATIONS 

An audit of the financial operations of the facility 
shall be performed by a public accountant at least 
once a year. 

Statutory Authority G.S. 131E-79. 

SECTION .3700 - MEDICAL STAFF 

.3701 GENERAL PROVISIONS 

The facility shall have an organized medical staff 
which shall be accountable to the governing body 
and which shall have responsibility for the quality 
of professional services provided by individuals 
with clinical privileges. Facility management shall 
have a mechanism to ensure that individuals with 
clinical privileges provide services within the 
scope of individual privileges granted. 

Statutory Authority G.S. 131E-79. 



.3702 COMPOSITION 

The medical staff shall 



be established in 



accordance with the by-laws, rules and regulations 
of the medical staff and with the by-laws of the 
facility. The governing body of the facility. after 
considering the recommendations of the medical 
staff, may grant clinical privileges to other 
qualified, licensed practitioners in accordance with 
their training, experience, and demonstrated 
competence and judgment in accordance with the 
medical staff by-laws. 

Statutory Authority G.S. 131E-79. 



.3703 APPOINTMENT AND 
REAPPOINTMENT 

Formal appointment for membership and 
granting of clinical privileges shall follow 

established procedures set forth in the by-laws. 



rules and regulations of the medical staff. These 
procedures shall require the following: 
(1) a signed application for membershi 
specifying age, year and school of 
graduation, date of licensure, statement 



of postgraduate or special training and 
experience with a statement of the scope 



121 



13) 



of the clinical privileges sought by the 

a pplicant; 

verification by the hospital of the 

qualifications of the applicant as stated in 



the application, including evidence of 
continuing education; 
written notice to the applicant from the 
medical staff and the governing body, 
regarding appointment or reappointment 



141 



which specifies the approval or denial of 
clinical privileges and the scope of the 
privileges granted; and 
members of the medical staff and other s 
granted clinical privileges in the facility 



shall hold current licenses to practice in 
North Carolina. 

Statutory Authority G.S. 131E-79. 

.3704 STATUS 

(a) Every facility shall have an active medical 



staff to deliver medical services within the facility 



The active medical staff shall be responsible for its 



own organization and administration. Every 



member of the active medical staff shall be eligible 



to vote at staff meetings and to hold office. 
(b) The medical staff shall determine categories 



for membership which shall be identified and 
defined in the medical staff bylaws. Examples are: 

(1) active medical staff; 

£21 associate medical staff; 

(3) courtesy medical staff; 

(4) temporary medical staff; 

(5) consulting medical staff; 

(6) honorary medical staff; or 

(7) other staff classifications. 
(c) Medical staff appointments shall be reviewed 



at least once every two years by the governing 
board. 

(d) Facility management shall maintain an 
individual file for each medical staff member 



Representatives of the Department shall have 
access to these files in accordance with G.S. 13 IE 



1784 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



80, 

(e) Minutes of aU actions taken by the medical 
staff and the governing board concerning the 
privileges granted shall be maintained. 

Statutory Authority G.S. 131E-79. 

.3705 MEDICAL STAFF BYLAWS, RULES 
AND REGULATIONS 

(a) The medical staff shall develop and adopt, 
subject to the a pproval of the governing body, a 
set of bylaws, rules and regulations, to establish a 
framework for self governance of medical staff 
activities and accountability to the governing body. 

(b) The medical staff bylaws, rules and 
regulations shall provide for at least the following: 

(1) organizational structure; 

(2) qualifications for staff membership; 

(3) procedures for admission, retention, 
assignment. and reduction or 
withdrawal of privileges; 

(4) procedures for fair hearing and appel- 
late review mechanisms for denial of 
staff appointments, reappointments, 
suspension, or revocation of clinical 
privileges; 

(5) composition, functions and attendance 
of standing committees; 

(6) policies for completion of medical 
records and procedures for disciplinary 
actions; 

(7) formal liaison between the medical staff 
and the governing body; 

(8) methods developed to formally verify 
that each medical staff member on 
appointment or rea ppointment agrees to 
abide by current medical staff bylaws 
and facility bylaws; and 

(9) procedures for members of medical 
staff participation in quality assurance 
functions. 



Statutory Authority G.S. 131E-79. 

.3706 ORGANIZATION AND 

RESPONSIBILITIES OF THE 
MEDICAL STAFF 

(a) The medical staff shall be organized to 
accomplish its required functions and provide for 
the election or appointment of its officers. 

(b) There shall be an executive committee, or its 
equivalent, which represents the medical staff, 
which has responsibility for the effectiveness of all 
medical activities of the staff, and which acts for 
the medical staff. 



(c) All minutes of proceedings of medical staff 
committees shall be recorded and available for 
inspections by members of the medical staff and 
the governing body. 

(d) The following reviews and functions shall be 
performed by the medical staff: 

(1) credentialing review; 
surgical case review; 
medical records review; 



m. 

oi 

14} 
(51 

£61 
III 
181 



medical care evaluation review; 

drug utilization review; 

radiation safety review; 

blood usage review; and 

bylaws review. 
(el There shall be medical staff and departmental 
meetings for the purpose of reviewing the 
performance of the medical staff, departments or 
services, and reports and recommendations of 
medical staff and multi-disciplinary committees. 
The medical staff shall ensure that minutes are 
taken at each meeting and retained in accordance 
with the policy of the facility. These minutes shall 
reflect the transactions, conclusions and 
recommendations of the meetings. 

Statutory Authority G.S. 131E-79. 

.3707 MEDICAL ORDERS 

(a) No medication or treatment shall be 
administered or discontinued except in response to 
the order of a member of the medical staff in 
accordance with established rules and regulations. 

(b) Such orders shall be dated and recorded 
directly in the patient chart or in a computer or 
data processing system which provides a hard copy 
printout of the order for the patient chart. A 
method shall be established to safeguard against 
fraudulent recordings. 

(c) All orders for medication or treatment shall 
be authenticated at the time of recordation by the 
ordering member of the medical staff except as 
specified in Paragraph (e) of this Rule. Authenti- 
cation must be accomplished by signature, initials, 
computer entry or code or other methods not 
inconsistent with the laws, rules and regulations of 
any other applicable jurisdictions. 

(d) The names of drugs shall be recorded in full 
and not abbreviated. 

(e) Verbal orders shall be taken and transcribed 
in the patient's medical record by personnel quali- 
fied according to medical staff rules. The tran- 
scription of medical orders shall be described in 
the medical staff by-laws and departmental policy. 
The order shall include the date, time, and full 
signature of the person taking the order and shall 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1785 



PROPOSED RULES 



be countersigned by a physician within 24 hours- 
Authentication must be accomplished by signature, 
initials, computer entry code, or other methods not 
inconsistent with the laws, rules and regulations of 
any other applicable jurisdictions. 

(f) The medical staff shall establish a written 
policy in conjunction with the pharmacy committee 
or its equivalent for al] medications not specifically 
prescribed as to time or number of doses to be 
automatically stopped after a reasonable time limit, 
but no more than 14 days. The prescriber shall be 
notified according to established policies and 
procedures at least 24 hours before an order is 
automatically stopped. 

Statutory Authority G.S. 131E-79. 

.3708 MEDICAL STAFF 

RESPONSIBILITIES FOR QUALITY 
IMPROVEMENT REVIEW 

(a) The medical staff shall have in effect a 
system to review medical services rendered, to 
assess quality, to provide a process for improving 
performance when indicated and to monitor the 
outcome. 

(b) The medical staff shall establish criteria for 
the evaluation of the quality of medical care. 

(c) Facility management shall have a written 
plan approved by the medical staff, administration 
and governing body which generates reports to 
permit identification of patient care problems. The 
plan shall establish a system to use this data to 
document and identify interventions. 

(d) The medical staff shall ensure that there is a 
continuous review process of the care rendered to 
both inpatients and outpatients in every medical 
department of the facility. At least quarterly, the 
medical staff shall have a meeting to review the 
process and results. The review process shall 
include both practitioners and allied health profes- 
sionals from the facility staff. 

(e) Minutes shall be taken at al[ meetings re- 
viewing quality improvement, and these minutes 
shall be made available to the medical staff on a 
regular basis in accordance with established policy. 
These minutes shall be retained as determined by 
the facility. 

Statutory Authority G.S. 131E-79. 

SECTION .3800 - NURSING SERVICES 

.3801 NURSE EXECUTIVE 

(a) If the facility utilizes a decentralized organi- 
zational structure, a nurse executive shall be 



responsible for the coordination of nursing organi 

zational functions. 

(b) A nurse executive shall develop facility wjdi 



patient care programs, policies and procedures tha 
describe how the nursing care needs of patients ar 



assessed, evaluated and met. 
(c) The nurse executive shall develop and adopt 



subject to the approval of facility management, i 
set of administrative policies and procedures to 
establish a framework to accomplish require 
functions. 

(d) There shall be scheduled meetings, at leas 
every 60 days, of the members of the nursing 



management staff to evaluate the quality am 

efficiency of nursing services. Minutes of thes 

meetings shall be maintained. 

(e) The nurse executive shall be responsible for 

(1) the development of a written organiza 



tional plan which describes the levels o 



accountability and responsibility withii 

the nursing organization; 

(2) identification of standards and policie 



£31 



£41 



151 



and procedures related to the deliver) 

of nursing care; 

planning for and the evaluation of ttu 

delivery of nursing care delivery sys 

tem; 

establishment of a mechanism to vali 



date qualifications, knowledge, am 
skills of nursing personnel; 
provision of orientation and educationa 



o pportunities related to expected nurs 
ing performance; and 
implementation of a system for perfor 
mance evaluation. 
(f) The nurse executive shall ensure that nursins 



£61 



care services are provided in conformance with the 



North Carolina Nursing Practice Act. 
(g) The nurse executive shall ensure that each 



member of the nursing staff is assigned clinica 



and or managerial responsibilities based upoi 



educational preparation, in conformance witt 



licensing laws and an assessment of current 



competence. Orientation and continuing educatior 

records shall be maintained. 

(h) Nurse executives shall ensure that staffing is 



based on a patient classification system which 



reflects the number of nursing personnel requirec 
for each patient unit. 

Statutory Authority C.S. 131E-79. 

.3802 NURSING STAFF 

(a) Licensed nurses and other nursing personnel 
shall be qualified by training, education, 



77*6 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



ex perience and demonstrated abilities to provide 
nursing care within their scope of practice. 

(b) Staffing schedules which reflect personnel 
assignment by date and service unit shall be kept 
on file for at least three years by hospital 
management. 

(c) Facility management shall establish policies 
for the provision of services for all contractual 
agreement personnel that include at a minimum the 
following: 

(1) verification of licensure or certification 
by the a ppropriate occupational board; 

(2) delivery and documentation of care; 

(3) participation on interdisciplinary care 
planning activities: and 

(4) supervision of contractual agreement 
personnel. 

Statutory Authority G.S. 131E-79. 

.3803 NURSING POLICIES AND 
PROCEDURES 

(a) A nurse executive shall ensure that nursing 
care policies and procedures are available to the 
nursing staff in each nursing care unit and service 
area. Nursing policies and procedures shall 
include the following: 

(1) method of noting diagnostic and 
therapeutic orders; 

(2) method of assigning nursing care of 
patients; 

(3) infection control measures; 

(4) patient safety measurers; and 

(5) method of implementing orders for 
medication or treatment. 

(b) Each unit shall have relevant clinical 
reference materials available. The following shall 
be provided to each unit: 

(1) a facility formulary or comparable drug 
reference; 

(2) a policy and procedure manual; and 

(3) a medical dictionary. 

(c) Facility management shall provide a program 
of inservice education which shall be maintained 
and documented for all nursing service personnel. 
Annual inservices shall include infection control 
measures, cardiopulmonary resuscitation and fire 
and safety. 

(d) Nursing care policies and procedures shall 
be reviewed at least every three years by the 
nursing staff and facility management and revised 
as necessary. They shall include the date to 
indicate the time of the most recent review or 
revision. 



Statutory Authority G.S. 131E-79. 

.3804 PATIENT CARE 

(a) Each patient's need for nursing care related 
to his or her admission shall be determined by a 
registered nurse. Patient needs shall be reassessed 
when warranted by the patient's condition. 

(b) Each patient's nursing care shall be based 
upon patient needs and shall be coordinated with 
the therapies of other disciplines. 

(c) The patient's medical record shall include 
documentation of: 

(1) the initial assessment and reassessments 
of patient clinical status; 

(2) patient care needs; 

(3) interventions identified to meet the 
patient's nursing care needs; 

(4) implementation of physician's orders; 

(5) the nursing care provided; and 

(6) the patient's response to, and the 
outcomes of. the care provided. 

(d) Each plan of care shall be initiated within 24 
hours of admission. The plan of care shall become 
a part of the clinical record. 

(e) The nursing care plan shall be readily 
available to all physicians and facility personnel 
involved with the care of the patient. 

Statutory Authority G.S. 131E-79. 

SECTION .3900 - MEDICAL 
RECORD SERVICES 

.3901 ORGANIZATION 

(a) Facility management shall establish a 
medical record service. It shall be directed, 
staffed and equipp ed to ensure the accurate 
processing, indexing and filing of al] medical 
records. Orientation, on-the-job training and in- 
service programs for medical records personnel 
shall be provided. 

(b) The medical record service shall be equipped 
to enable its personnel to maintain medical records 
so that they are readily accessible and secure from 
unauthorized use. 

Statutory Authority G.S. 131E-79. 

.3902 MANAGER 

(a) The medical records service shall be directed 
and supervised by a qualified medical records 
manager. If the manager is not a registered record 
administrator or an accredited records technician, 
the facility shall retain a person with those 
qualifications on a part-time or consulting basis. 



9:21 



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February 1, 1995 



1787 



PROPOSED RULES 



(b) The manager of the medical record service 
shall advise, administer, supervise and perform 
work involved in the development, analysis, 
maintenance and use of medical records and 
reports. 

(c) Where the manager is employed on a part- 
time or consulting basis, he or she shall organize 
the department, train the regular personnel and 
make periodic visits to the facility. The manager 
shall evaluate the records and the operation of the 
service and document the visits by written reports. 
A written contract specifying his or her duties and 
responsibilities shall be kept on file and made 
available for inspection by the Division's surveyor. 

(d) The manager of the medical record service 
shall maintain a system of identification and filing 
to facilitate the prompt location of medical record 
of any patient. 

(e) The manager of the medical records service 
shall ensure that medical records are stored in such 
a manner as to provide protection from loss, 
damage, and unauthorized access. 

Statutory Authority G.S. 131E-79. 

.3903 PRESERVATION OF MEDICAL 
RECORDS 

(a) The manager of medical records service shall 
ensure that medical records, whether original, 
computer media, or microfilm, be kept on file for 
a minimum of H. years following the discharge of 
an adult patient. 

(b) The manager of medical records shall ensure 
that if the patient is a minor, records shall be kept 
on file until his 19th birthday and, then, for 1 1 
years. 

(c) If a hospital discontinues operation, its 
management shall make known to the Division 
where its records are stored. Records are to be 
stored in a business offering retrieval services for 
at least 1 1 years after the closure date. 

(d) Prior to destruction, public notice shall be 
made to permit former patients or their 
representatives to claim their own records. Public 
notice shall be in at least two forms: written notice 
to the former patient or their representative and 
display of an advertisement in a newspaper of 
general circulation in the area of the facility. 

(e) The manager of medical records may 



authorize the microfilming of medical records. 
Microfilming may be done on or off the premises. 
If done off the premises, the facility shall take 
precautions to ensure the confidentiality and 
safekeeping of the records. The original of 
microfilmed medical records shall not be destroyed 



until the medical records department has had an 

opportunity to review the processed film foi 

content. 

(f) Nothing in this section shall be construed tn 



pro hibit the use of automation in the medical 



records service, provided that all of the provision? 



in this subsection are met and the information is 
readily available for use in patient care. 

(g) All medical records are confidential. Qnl 
authorized personnel shall have access to the 
records. The written authorization of the patient 
shall be maintained in the original record as 
authority for release of medical information 



outside the facility. 

(h) Medical records are the property of the 
hospital, and they shall not be removed from the 
facility jurisdiction except through a court order. 
Copies shall be made available for authorized 



purposes such as insurance claims and physician 
review. 

Statutory Authority G.S. 131E-79. 

.3904 PATDZNT ACCESS 

The manager of medical records shall ensure that 
patients or patient designees, when requested, are 
given access to or a copy of their medical records. 
or both. Upon the death of a patient, the executor 
of the decedent's estate, or in the absence of an 
executor, the next of kin responsible for the 
disposition of the remains, shall have access to all 
medical records of the deceased patient. The 
patient or the patient's next of kin may be charged 
for the cost of reproducing copies in accordance 
with G.S. 90-411. 

Statutory Authority G.S. 131E-79. 

.3905 PATIENT MEDICAL RECORDS 

(a) Hospital management shall ensure that 
medical records are maintained for every patient 
treated or examined in the facility. 

(b) The medical record or medical record system 
shall provide data for each episode of care and 
treatment rendered by the facility. 

(c) Where the medical record does not combine 



all episodes of inpatient, outpatient and emergency 
care, the medical records system shall: 

(1) assemble, upon request of the 
physician, any or al] divergently located 
components of the medical record when 
a patient is admitted to the facility or 
appears for outpatient or clinic services; 
or 

(2) require placing copies of pertinent 



1788 



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9:21 



PROPOSED RULES 



portions of each inpatient's medical 
record, such as the discharge resume, 
the operative note and the pathology 
report in the outpatient or combined 
outpatient emergency unit record file as 
directed by the medical staff. 
(d) The manager of medical records shall 
ensure: 

(1) each patient's medical record is 
complete, readily accessible and 
available to the professional staff 
concerned with the care and treatment 
of the patient; 

(2) all significant clinical information 
pertaining to a patient is incorporated in 
his medical record; 

(3) all entries in the record are dated and 
authenticated by the person making the 
entry; 

(4) symbols and abbreviations are used 
only when they have been a pproved by 
the medical staff and when there exists 
a legend to explain them; 

(5) verbal orders include the date and 
signature of the person recording them. 
They shall be given and authenticated in 
accordance with the provisions of Rule 
.3707(e) of this Subchapter; and 

(6) records of patients discharged are 
completed within 30 days following 
discharge or disciplinary action is 
initiated as defined in the medical staff 
bylaws. 

Statutory Authority G.S. 131E-79. 

.3906 CONTENTS 

(a) The medical record shall contain sufficient 
information to justify the diagnosis, verify the 
treatment and document the course of treatment 



and results accurately. 

(b) All in-patient records 
following information: 



shall include the 



(1) identification data (name, address, age, 
sex) and, when the identification data is 
not obtainable, the reason for such; 

(2) date and time of admission and 
discharge; 

(3) medical history; 
chief complaint; 



£A) 

m 

£Q 
£B) 



details of the present illness; 

relevant past, social, and family 

histories; and 

reports of relevant physical 

examinations; 



£41 
£5) 

16) 

01 

18) 

12) 

(10) 
£LQ 

(12) 

(13) 
(14) 



diagnostic and therapeutic orders; 

reports of procedures, tests and their 

results; 

provisional or admitting diagnosis; 

evidence of appropriate informed 

consent; 

clinical observations. 



including results 



of therapy; 
record of 



medication and treatment 



£15) 



administration; 

progress notes of all disciplines; 
conclusions at termination of 
hospitalization or evaluation and 
treatment; 

all relevant diagnosis established by the 
time of discharge; 
consultation reports: 
surgical record, including anesthesia 
record, pre-operative diagnosis, 
surgeon's operative report and post- 
operative orders and any instructions 
given to the patient or family; and 
autop sy findings, if performed. 



Statutory Authority G.S. 131E-79. 

.3907 MEDICAL RECORDS REVDZW 

The medical staff shall review records 
periodically for completeness and shall: 

(1) establish requirements regarding 
completion of medical records, including 
a system for disciplinary actions for those 
who do not complete records in a timely 
manner; and 

(2) make recommendations to the medical 
records department to ensure that the 
recorded clinical information is sufficient 
for the purpose of medical care 
evaluation. 

Statutory Authority G.S. 131E-79. 

SECTION .4000 - OUTPATD2NT 
SERVICES 

.4001 ORGANIZATION 

(a) Facility management shall assure that the 
type and scope of outpatient care services is 
established in accordance with the facility's written 
mission statement. 



(b) The relationship of outpatient services to 
other divisions within the facility, including 
channels of responsibility and authority, shall be 
documented and made available for review by 
facility management. 



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1789 



PROPOSED RULES 



(c) Facility management shall vest the direction 
of outpatient services in one or more individuals 
whose qualifications, authority and duties are 
defined in writing. 

£d} The facility management shall ensure the 
review and evaluation of outpatient services. 

(e) Each medical staff member shall have 
privileges delineated in accordance with criteria 
established by the medical staff by-laws. 

Statutory Authority G.S. 131E-79. 

.4002 STAFFING 

(a) The director of outpatient services shall 
ensure that ambulatory care services are staffed 
with sufficient personnel in accordance with a 
written plan. 

(b) The responsibility for the delivery of 
outpatient services by the professional staff shall 
be clearly defined and documented by the director 
of ambulatory care services. 

(c) Facility management shall provide education 
programs specifically related to outpatient care for 
the staff and document the extent of participation 
in education and training programs. 

Statutory Authority G.S. 131E-79. 

.4003 POLICIES AND PROCEDURES 

(a) The provision of outpatient services shall be 
guided by written policies and procedures which 
are current and approved by the medical staff. 
The policies and procedures shall be reviewed at 
least every three years. 

(b) The policies shall include the following: 
(P patient access to outpatient services; 

the process of obtaining informed 

consent; 

the location, storage and procurement 

of medications, supplies and equipment; 

and 

the mechanism to be used to contact 



(21 

01 



[4) 



patients for necessary follow-up. 



Statutory Authority G. S 131E-79. 

.4004 OUTPATIENT SURGICAL AND 
ANESTHESIA SERVICES 

(a) When surgical or anesthesia services are 
provided in an outpatient setting, the facility shall 
ensure that the medical staff a pprove all types of 
surgical procedures to be offered. The facility 
shall maintain and make available a current listing 
of approved outpatient procedures. 

(b) The facility shall define the scope of 



anesthesia services that may be provided, th 
locations where such anesthesia services may b 
administered and who shall provide anesthesi 
services, 
(c) The facility shall ensure that requirement 



for informed consent, history and physic; 



examination, preoperative studies, administrate 



of anesthesia, medical records and discharg 



criteria meet the same standards of care as appl 
for inpatient surgery unless otherwise specified b 
the medical staff. 

£d_l The facility shall ensure that provisions b 
made for back-up service by other departments i 



the case of emergencies or complications. 
Statutory Authority G.S. 131E-79. 

.4005 MEDICAL RECORDS 

(a) The manager of outpatient services sha 
ensure that a record of outpatient care and service 



is developed for each patient and maintained eith< 



in the ambulatory care services or medical record 
department. 

(b) Facility management shall ensure that 
system of identification and filing as develope c 



which will ensure safe storage and prompt retriev; 



upon subsequent inpatient or outpatient visits. 

£cj Facility management shall ensure th 
medical records procedures include provisions fo 
maintaining the confidentiality of patiei 



information and for the release of information t 
authorized individuals. 

Statutory Authority G.S. 131E-79. 

SECTION .4100 - EMERGENCY 
SERVICES 

.4101 EMERGENCY RESPONSE 
CAPABILITY REQUIRED 

The medical staff of each facility shall ensur 
that facility personnel are capable of initiating life 
saving measures at a first-aid level of response fo 
any patient or person in need of such services 
This shall include: 

(11 initiating basic cardio-respirator 



resuscitation according to American Re 
Cross or American Heart Associatio 



121 
(31 
(41 



standards; 

availability of first-line emergency drug 
as specified by the medical staff; 
availability of IV fluids and supplie 
required to establish IV access; and 
establishing protocols or agreements ft 
the transfer of patients to a facility for 



1790 



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9:2 



PROPOSED RULES 



higher level of care when these services 
are not available on site. 

Statutory Authority G. S. 131E-79. 

.4102 CLASSIFICATION OF OPTIONAL 
EMERGENCY SERVICES 

(a) Facility management of any facility 
providing emergency services shall classify its 
capability in providing such services according to 
the following criteria: 
£1} Level I: 

(A) the facility shall have a 
comprehensive, 24-hour-per-day 
emergency service with at least one 
physician experienced in emergency 
care on duty in the emergency care 
area; 

(B) the facility shall have in-hospital 
physician coverage by members of the 
medical staff or by senior-level 
residents for at least medical, 
surgical, orthopedic, obstetric. 



gynecologic, pediatric and anesthesia 
services; 

(C) services of other medical and surgical 
specialists shall be available; and 

(D) the facility shall provide prompt 
access to labs, radiology, operating 
suites, critical care and obstetric units 
and other services as defined by the 
governing body. 

{2} Level II: 

(A) the facility shall have 24-hour p er day 
emergency service with at least one 
physician experienced in emergency 
care on duty in the emergency care 
area; and 

(B) the facility shall have consultation 
available within 30 minutes by 
members of the medical staff or by 
senior level residents to meet the 
needs of the patient. Consultation by 
phone is acceptable. 

(3) Level III: The facility shall have 
emergency service available 24 hours 
per day with at least one physician 
available to the emergency care area 
within 30 minutes through a medical 
staff call roster- 



CD) Facilities seeking trauma center designation 
shall comply with G.S. 131E-162. 

(c) The location of the emergency access area 
shall be identified by clearly visible signs. 



Statutory Authority G.S. 131E-79. 

.4103 PROVISION OF EMERGENCY 
SERVICES 

(a) Facility management of any facility 
providing emergency services shall ensure that 
medical screening, treatment and transfer services 
for any individual who presents to the facility 
emergency department and on whose behalf a 
request for treatment is made shall be provided 
regardless of that person's ability to pay for 
medical services. 

(b) Facility management shall ensure that the 
facility shall not delay provision of the medical 
screening examination or treatment required in 
order to inquire about the individual's method of 
payment status. 

(c) Any facility providing emergency services 
under this section shall install, operate and 
maintain, on a 24-hour per day basis, an 
emergency two-way radio licensed by the Federal 
Communications Commission in the Public Safety 
Radio Service capable of establishing voice radio 
communication with ambulance units transporting 
patients to said facility or having any written 
procedure or agreement for handling emergency 
services with the local ambulance service, rescue 
squad or other trained medical personnel. 

(d) All communication equipment shall be in 
compliance with current rules established by North 
Carolina Rules for Basic Life Support/ Ambulance 
Service (10 NCAC 3 .1100) adopted by reference 
with all subsequent amendments. Referenced rules 
are available at no charge from the Office of 
Emergency Medical Service, P.O. Box 29530, 
Raleigh. N.C. 27626-0530. 

Statutory Authority G.S. 131E-79. 

.4104 MEDICAL DIRECTOR 

(a) The governing body shall establish the 
qualifications, duties, and authority of the director 
of emergency services. A ppointments shall be 
recommended by the medical staff and approved 
by the governing body. 

(b) The medical staff credentials committee shall 
approve the mechanism for emergency privileges 
for physicians employed for brief periods of time 
such as evenings, weekends or holidays. 

(c) Level I and II emergency services shall be 
directed and supervised by a physician with 
experience in emergency care. 

(d) Level III services shall be directed and 
supervised by a physician with experience in 
emergency care or through a multi-disciplinary 



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February 1, 1995 



1791 



PROPOSED RULES 



medical staff committee. The chairman of this 
committee shall serve as director of emergency 
medical services. 



Statutory Authority G.S. 131E-79. 

.4105 NURSING 

(a) Level I and Level II emergency services 
shall have one or more registered nurses assigned 
and on duty within the emergency service area at 
all times. 

£b) A Level HI emergency service shall have a 
registered nurse available on at least an on-call, in- 
house basis at all times. 

(c) All emergency services nursing personnel 
shall have documented orientation, training and 
continuing education in the reception and care of 
emergency patients. 

Statutory Authority G.S. 131E-79. 

.4106 POLICIES AND PROCEDURES 

Each emergency de partment shall establish 
written policies and procedures which specify the 
scope and conduct of patient care to be provided in 
the emergency areas. They shall include the 
following: 

(1) the location, storage, and procurement of 
medications, blood, su pplies, equipment 
and the procedures to be followed in the 
event of equipment failure; 

(2) the initial management of patients with 
burns, hand injuries, head injuries, 
fractures, multiple injuries, poisoning, 
animal bites, gunshot or stab wounds and 
other acute problems; 

(3) the provision of care to an unemancipated 
minor not accompanied by a parent or 
guardian, or to an unaccompanied 
unconscious patient; 

(4) management of alleged or suspected 
child, elder or adult abuse; 

(5) the management of pediatric emergencies; 

(6) the initial management of patients with 
actual or suspected exposure to radiation; 

(7) management of alleged or suspected rape 
victims; 

(8) the reporting of individuals dead on 
arrival to the proper authorities; 

(9) the use of standing orders; 

(10) tetanus and rabies prevention or 
prophylaxis; and 

(11) the dispensing 



of medications in 



accordance with state and federal laws. 



Statutory Authority G.S. 131E-79. 

.4107 EMERGENCY RECORDS 

(a) Facility management shall ensure all levels 
of emergency departments maintain a continuous 
control register on each patient seen for services 
which shall include at least the name, age, sex, 
date, time, and means of arrival, nature of 
complaint, disposition, and time of discharge. 

(b) Facility management shall ensure that a 
record shall be maintained for each patient seeking 
emergency care. This shall include: 

(1) patient identification, time and means of 
arrival; 

(2) pertinent history and physical findings 
and patient vital signs; 

(3) diagnostic and therapeutic orders: 

(4) clinical observations including results of 
treatment; 

(5) reports of procedures, tests and results: 

(6) diagnostic impression; and 

(7) discharge or transfer summary of 
treatment including final disposition, 
the patient's condition, and any 
instructions given to the patient and or 
family for follow-up care. 

Statutory Authority G.S. 131E-79. 

.4108 OBSERVATION BEDS 

When observation beds are used, facility 
management shall ensure that there shall be written 
policies and procedures that address the type of 
patient use, the mechanism for providing 
appropriate clinical monitoring, the length of time 
services may be provided in this setting and 
documentation requirements. 

Statutory Authority G.S. 131E-79. 

.4109 TRANSFER 

(a) Facility management shall ensure that the 
facility has established protocols for stabilization 
and transportation of emergency patients. 

fb) A facility with specialized capabilities, such 
as burn units, shock-trauma units and neonatal 
intensive care units, shall not refuse to accept an 
appropriate transfer for those services if the 
hospital has the capacity to treat the individual. 

(c) Hospital management shall ensure that a 
patient shall not be transferred until the receiving 
organization has consented to accept the patient 
and the patient is sufficiently stable for transport. 

(d) If the patient or the person acting on the 
patient's behalf refuses transfer, the facility staff 



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February 1, 1995 



9:21 



PROPOSED RULES 



shall: 

(1) explain to the individual or his repre- 
sentative the risks and benefits of trans- 
fer; and 

(2) shall request the patient's or his 
representative's refusal of transfer in 
writing. 

(e) Facility management shall ensure that a copy 
of all medical records related to the emergency 
condition for which the individual has presented 



shall be made available at the time of the transfer, 
and shall accompany the patient to the receiving 
facility. 

Statutory Authority G. S. 131E-79. 

.4110 DISASTER AND MASS 
CASUALTY PROGRAM 

(a) Facility management shall describe: 

(1) the level of emergency services avail- 
able during an external disaster; 

(2) the emergency department's place in the 
facility's external disaster plan; 

(3) procedures to be followed in the event 
of an internal disaster; and 

(4) the facility's connection to other com- 
munity services such as fire, police and 
the American Red Cross. 

(b) The medical staff and governing body shall 
approve the plan, review it and revise it if needed. 



annually. 



(c) The plan shall: 

(1) provide for prompt medical attention 
for all emergency patients as their 
needs may dictate; 

(2) include protocols for handling non- 
emergency cases; 

(3) establish medical staff coverage proce- 
dures or methods; 

(4) specify drugs, solutions and equipment 
to be continuously available; 

(5) provide for the evacuation and transfer 
for all inpatients as there needs may 
indicate in the event of an internal 
disaster; and 

(6") include mutual support agreements with 
area providers. 
{d} Schedules, names and telephone numbers of 
all physicians and others on emergency duty shall 
be maintained by the facility. 



(e) Names and telephone numbers of those to be 
contacted in the event of an internal disaster shall 



be maintained by the facility. 
Statutory Authority G. S. 131E-79. 



SECTION .4200 - SPECIAL 
CARE UNITS 

.4201 ORGANIZATION 

(a) The governing body shall approve the type 
and scope of special care units. 

(b) Facility management shall assure that the 
relationship of the special care units to the other 
departments within the hospital, including channels 
of responsibility and authority, be documented and 
available for review. 

(c) Facility management shall ensure that there 
are necessary equipment and supplies for delivery 
of nursing care specific to the unit population for 
each special care unit. 

(d) Facility management shall ensure that the 
facility has sufficient emergency drugs and equip- 
ment to meet anticipated needs as determined by 
the medical staff. 

(e) The governing body shall delegate to the 
medical and nursing staff the responsibility to 
develop policies and procedures concerning the 
scope and provision of safe care in each unit. 

Statutory Authority G.S. 131E-79. 

.4202 MEDICAL STAFF 

(a) The governing body shall ensure that each 
special care unit or group of similar units be 
directed by qualified members of the medical staff 
whose clinical and administrative privileges have 
been approved by the governing board. 

(b) The governing body shall designate the 
director to be responsible for making decisions in 
consultation with the physician responsible for the 
patient, for the disposition of a patient when 
patient load exceeds optimal operation capacity. 

(c) The governing body shall ensure that the 
medical staff provide medical staff coverage 
sufficient to meet the specific needs of the patients 
on a 24-hour basis. 

Statutory Authority G.S. 131E-79. 

.4203 NURSING STAFF 

Facility management shall ensure the supervision 
of nursing care for each special care unit be 
provided by a qualified registered nurse. The 
supervisor shall ensure the following: 

(1) unit-specific orientation and competency 
evaluation for each staff member; 

(2) a staffing plan based upon the needs of 
the patient population which is imple- 
mented to ensure a sufficient number of 
qualified Registered Nurses are on duty 



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1793 



PROPOSED RULES 



when patients are in the unit; 

(3) assessment, planning, implementation and 
evaluation of nursing care which is 
documented according to policy; and 

(4) delivery of nursing care in accordance 
with the North Carolina Nurse Practice 
Act. 

Statutory Authority G.S. 131E-79. 

.4204 POLICIES AND PROCEDURES 

(a) Facility management shall assure that written 
policies and procedures which guide the provision 
of care be developed by the medical and nursing 
staff. Facility management shall ensure that 
policies and procedures are a pproved by the 
medical staff and that they include: 

(1) patient admission and discharge criteria; 

(2) notification of appropriate medical staff 
for changes in the condition of the 
patient; 

(3) use of standing orders and emergency 
protocols; 

(4) designation of staff members authorized 
to perform special procedures and 
special circumstances requiring such 
authorization; 

(5) patient care procedures, including 
medication administration; 

(6) infection control; 

(7) pertinent safety practices; 

(8) use of equipment and procedures to be 
followed in the even of equipment 
failure; 

(9) regulations governing visitors and 
traffic control; and 

(10) role of special care unit in internal and 
external disaster plans. 

(b) Th e governing body shall review, update and 
approve regularly, but at least every three years, 
its policies and procedures. 

Statutory Authority G.S. 131E-79. 

SECTION .4300 - MATERNAL - 
NEONATAL SERVICES 

.4301 ORGANIZATION MATERNAL 
SERVICES 

(a) The governing body shall a pprove the scope 
of obstetric services offered based upon the level 
of patient need, qualifications of the credential ed 
staff, and resources of the facility. 

(b) The following capabilities and minimum 
services shall be made available when obstetric 



services are provided: 

(1) identification of high-risk mothers and 
fetuses; 

(2) continuous electronic fetal monitoring; 

(3) cesarean delivery capability within 30 
minutes of decision: 



14) 
151 
16} 

[81 
£91 

(10) 

on 

(12) 



blood or fresh frozen plasma for 

transfusion; 

anesthesia on a 24-hour or on-call 

basis; 

radiology and ultrasound examination; 

stabilization of unexpectedly small or 

sick neonates before transfer; 

neonatal resuscitation; 



laboratory services on a 24-hour or on- 
call basis; 

consultation and transfer agreements: 
assessment and care for the neonates: 
and 

nursery or other a ppropriate space for 
care of the neonates. 
(c) In a facility without intensive care nursery 
services, the facility management shall establish 
procedures for the stabilization and transportation 
of sick newborns to a regional neonatal unit and 
maintain the essential equipment necessary for 
transport. 

Statutory Authority G.S. 131E-79. 

.4302 MEDICAL DIRECTOR MATERNAL 
SERVICES 

(a) The medical staff shall ensure that each birth 
is attended by a physician or certified nurse 
midwife who has documented evidence of current 
competence and appropriate privileges. 

£b_l Medical staff with obstetrical privileges shall 
be available in the facility to provide services 
within 30 minutes at all times to attend deliveries. 
An on-call schedule shall be available to the 
Division for review. 

Statutory Authority G.S. 131E-79. 

.4303 NURSING SERVICES MATERNAL 
SERVICES 

(a) The nurse executive or the decentralized 
nursing management staff shall designate a 
registered nurse who has education, training, and 
ex perience in obstetrical care as supervisor of 
obstetrical services. 

(b) A registered nurse shall be assigned 
responsibility for providing the type and amount of 
nursing care needed by each patient. A staffing 
plan shall be available to the Division for review. 



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9:21 



PROPOSED RULES 



Statutory Authority G.S. 131E-79. 

.4304 POLICIES AND PROCEDURES 
MATERNAL SERVICES 

(a) The provision of patient care shall be guided 
by. written policies and procedures developed by 
the medical and nursing staff and approved by the 
medical staff. 

(b) Written policies shall relate to at least the 
following: 

(1) a system for informing the physician 
responsible for a patient of the 
following: 

(A) the patient's admission; 

(B) the onset of labor; and 

(C) pertinent information about progress 
of labor or changes in patient's 
condition. 

emergency response protocols for 

patients who demonstrate evidence of 

maternal, fetal or neonatal distress; 

a program to prevent isoimmunization 

of RH-negative mothers; 

administration of oxytocic agents when 

used for induction or stimulation of 

labor; 

the use and administration of analgesics 

and anesthetics; 

administration of magnesium sulfate 

when and for the treatment 

preeclampsia; 

explicit directions as to the location and 

storage of medications, supplies, and 

special equipment; 

the method of identification for the 

neonates; 

assessment and care of the neonates; 



m 

13} 
£4i 

(51 
16} 

m 

£81 

121 
(10) 



provision of resuscitation, stabilization, 
and preparation for the transport of sick 
newborns at any hour; and 
(11) an infection control plan, 
(c) Accurate and complete medical records shall 
be provided for each obstetric patient. 

Statutory Authority G.S. 131E-79. 

.4305 ORGANIZATION OF NEONATAL 
SERVICES 

(a) The governing body shall approve the scope 
of all neonatal services and the facility 
management shall classify its capability in 
providing a range of neonatal services using the 
following criteria: 

(1) LEVEL I or Neonate Nursery: 
neonates that are stable without 



complications; may include premature. 

small for gestational age or large for 

gestational age neonates; 
(2) LEVEL II: 111 neonates or infants 

requiring less constant nursing care but 

does not exclude respiratory su pport; 

may serve as "step-down" unit from 

LEVEL III; and 
131 LEVEL HI: Medically unstable or 

critically ill neonates requiring constant 

nursing care or supervision involving 

complicated surgical procedures. 

continual respiratory or other intensive 

interventions. 

(b) Facility management shall ensure the 
availability of equipment su pplies, and clinical 
su pport services. 

(c) The medical and nursing staff shall develop 
and a pprove policies and procedures for the 
provision of all neonatal services. 

Statutory Authority G.S. 131E-79. 

.4306 MEDICAL STAFF OF NEONATAL 
SERVICES 

The medical staff shall ensure the director or 
other designated physician in charge of the 
neonatal special or intensive care unit has training 
and experience in care of the neonate. 

Statutory Authority G.S. 131E-79. 

.4307 NURSING STAFF OF NEONATAL 
SERVICES 

(a) The nurse executive or the decentralized 
nursing management staff shall designate a 
registered nurse who has training and experience 
in the care of neonates as supervisor of neonatal 
services. 

(b) A registered nurse shall be assigned 
responsibility for providing the type and amount of 
nursing care needed by each patient. A staffing 
plan shall be available to the Division for review. 

(c) The nursing staff shall provide educational 
opportunities for parents of neonates on routine 
care and procedures needed by the neonate. 

(d) The nursing staff shall provide opportunities 
for parental participation in care of the neonate to 
facilitate bonding and family adjustment to the 
neonate's needs. 

Statutory Authority G.S. 131E-79. 

.4308 POLICIES AND PROCEDURES OF 
NEONATAL SERVICES 



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NORTH CAROLINA REGISTER 



February 1, 1995 



1795 



PROPOSED RULES 



(a) The provision of neonatal care at all levels 
shall be guided by written policies and procedures. 

(b) The policies and procedures shall include but 
are not limited to; 

111 



12) 

141 
151 
161 

ill 



emergency resuscitation and 
stabilization of the neonate; 
equipment for routine and emergency 
care of the neonate; 

continuous oxygen supply and means of 
administration including ventilators; 
administration of medications; 
insertion and care of invasive lines; 
of 



prevention 



infectious diseases or 



processes transmission; and 
family involvement in care 
neonate. 



of the 



(c) The medical and nursing staff shall review, 
update and approve regularly, but at least every 
three years its policies and procedures. 

Statutory Authority G.S. 131E-79. 

SECTION .4400 - RESPIRATORY 
CARE SERVICES 

.4401 ORGANIZATION 

(a) The governing body shall appoint a medical 
director of the respiratory care service who is an 
anesthesiologist, pulmonolgist or other qualified 
physician. 

(b) Facility management shall appoint a qualified 
individual as the director of respiratory care 
services, 

(c) The director of the service shall designated 
a qualified person to supervise the respiratory care 
staff. 

(d) When the facility is without a distinct 
respiratory care service, facility management shall: 

(1) designate the department responsible for 
the delivery of respiratory care 
services; 

(2) designate a person to supervise the 
delivery of respiratory care services; 
and 

(3) establish policies and procedures for the 
delivery of respiratory care services 
offered. 

Statutory Authority G.S. 131E-79. 

.4402 STAFFING 

(a) Staffing numbers shall be determined by the 
types and complexities of the services offered. 

(b) The director of the service shall ensure the 
availability of trained respiratory technicians. 



Certified Respirators' Therapy Technicians. 
registry eligible or Registered Respiratory 
Therapist needed for the scope of services offered. 



Statutory Authority G.S. 131E-79. 

.4403 POLICIES AND PROCEDURES 

Facility management shall establish written 
policies and procedures for the services offered. 
These shall include but are not limited to: 

(1) scope of services and treatment offered: 

(2) medication administration; 

(3) cleaning, assembly and storage of 
equipment; 

(4) safety; 

(5) infection control; 

(6) documentation of delivered care or 
treatments; and 

(7) care and supervision of all ventilated 
patients. 

Statutory Authority G.S. 131E-79. 

SECTION .4500 - PHARMACY 

SERVICES AND MEDICATION 

ADMINISTRATION 

.4501 PROVISION OF SERVICE 

The facility shall provide for pharmaceutical 
services which are administered in accordance with 
the pharmacy laws of North Carolina including but 
not limited to GJL 90 and G.S. 106. 

Statutory Authority G. S. 131E-79. 

.4502 PHARMACIST 

(a) The pharmacy service shall be directed by a 
pharmacist licensed by the State of North Carolina. 
If a facility has a limited service as defined by the 
N.C. Board of Pharmacy, a part-time director of 
pharmacy shall have responsibility for control and 
dispensing of drugs. 

(b) The director of pharmacy shall be 
responsible to the chief executive officer or his 
designee for developing, supervising, and 
coordinating all the activities of pharmacy services 
throughout the facility. 

(c) The director of pharmacy shall ensure that 
the pharmacists are trained in the specialized 
functions of facility pharmacy. 

(d) The dispensing of drugs in the absence of a 
pharmacist shall be members who are under the 
direct supervision of staff approved by the 
pharmacy committee and who are responsible for 
following policies established by the pharmacy 



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PROPOSED RULES 



committee. 

Statutory Authority G.S. 131E-79. 

.4503 STAFF 

The director of pharmacy shall be assisted by 
additional pharmacists and such other personnel as 
the activities of the pharmacy may require to meet 
the pharmaceutical needs of the patients served. 

Statutory Authority G.S. 131E-79. 

.4504 PHARMACY COMMITTEE 

(a) A pharmacy committee or its equivalent, to 
include physicians, nurses, pharmacists and the 
administrator or designee shall be established. 

(b) The committee shall meet at least quarterly, 
record its proceedings and report to the medical 
staff. It shall assist in the formulation of broad 
professional policies regarding the evaluation, 
appraisal. selection. procurement, storage, 
distribution, use and safety procedures, and all 
other matters relating to drugs in the facility. This 
should include a mechanism to review and evaluate 
adverse drug reactions and drug usage evaluations, 
offering appropriate recommendations, actions, 
and follow-up if necessary. The committee shall: 

(1) serve as an advisory group to the 
medical staff and the pharmacy director 
on matters pertaining to drug selection; 
develop an ongoing mechanism to 
review a formulary or drug list for use 
in the hospital; 

recommend and develop policies 
regarding the use and control of 
investigational drugs and research in the 
use of U.S. Food and Drug 
Administration approved drugs; 

(4) evaluate clinical data concerning new 
drugs or preparations requested for use 
in the facility; 

(5) make recommendations concerning 
drugs to be stocked on the nursing units 
and by other services; 

(6) establish mechanisms which will 
prevent formulary duplication; 

(7) establish policies and procedures that 
address therapeutic drug substitution; 

(8) establish a policy to ensure that the 
duration of drug therapy or number of 
doses is established for all medication 
orders; and 

(9) make recommendations regarding 
medication administration policies and 
procedures. 



12} 



IH 



Statutory Authority G.S. 131E-79. 

.4505 PHARMACY FACILITIES 

Facility management shall provide equipment and 
supplies for the pharmaceutical service to carry out 
its professional and administrative functions and to 
ensure patient safety through the proper storage 
and dispensing of drugs. Space and equipment 
shall be provided for the storage, safeguarding, 
preparation and dispensing of drugs. 

Statutory Authority G.S. 131E-79. 

.4506 SUPPLIES 

The director of pharmacy shall ensure that a 
supply of drugs and pharmaceutical devices 
adequate to meet the needs of the patients and the 
medical staff is maintained. 

Statutory Authority G.S. 131E-79. 

.4507 STORAGE 

(a) All drugs and related pharmaceutical supplies 
located throughout the facility shall be under the 
control of the pharmacy service. 

(b) All areas where drugs and related 
pharmaceutical supplies are stored shall be 
monitored at least monthly by the pharmacy 
service. 

(c) The director of pharmacy shall ensure that 
corresponding records are maintained of drug 
inventory variances and the corrective action 
taken. 

Statutory Authority G.S. 131E-79. 

.4508 SPACE 

Adequate space shall be provided for all 
pharmacy operations and drugs shall be stored in 
a satisfactory location provided with proper 
lighting, ventilation and temperature controls, as 
specified by the U. S^ Food & Drug 
Administration. Dockets Management Branch, 
FDS, Room 4-62, 5600 Fishers Lane, Rockville, 
Maryland 20857; at a cost dependent on the 
material requested and the U.S. Pharmacopoeia, 
US Pharmacopoeia, 12601 Twinbrook Parkway, 
Rockville. Maryland 20852 (1-800-227-8772), at 
a cost of four hundred fifty dollars ($450.00) plus 
twelve dollars ($12.00) shipping and handling. 

Statutory Authority G.S. 131E-79. 

.4509 SECURITY 

(a) The director of pharmacy shall ensure that 



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February 1, 1995 



1797 



PROPOSED RULES 



all drugs and related pharmaceutical supplies be 
stored in a lockable environment except when 
under the direct supervision of personnel 
authorized by the pharmacy committee to handle 
drugs. 

(b) Controlled substances and other drugs the 
facility deems subject to abuse shall be stored as 
outlined in the U.S. Controlled Substance Act, 
CFR 1301.41 and the N.C. Controlled Substances 
Act, G.S. 90, Article 5^ These rules are available 
from the Regulatory Section of the N.C. Division 
of Mental health. Development Disabilities & 
Substnace Abuse Services, 325 N. Salisbury St., 
Raleigh, N.C. 27603 (919/715-0652) without 
charge to current registrants. 

(c) All keys and other locking devices to the 
pharmacy and controlled substances throughout the 
facility shall be under the control of the director of 
pharmacy and the hospital management. 

Statutory Authority G.S. 131E-79. 

.4510 RECORDS 

(a) The director of pharmacy shall ensure that 
all drug transactions of the pharmacy shall be 
recorded as described in policies a pproved by the 
pharmacy committee. 

(b) The director of pharmacy shall establish and 
maintain a system of records and bookkeeping in 
accordance with the policies of the facility in order 
to maintain adequate control over the 
requisitioning and dispensing of all drugs and 
pharmaceutical supplies and over patient billing for 
all drugs and pharmaceutical supplies. 

(c) The director of pharmacy shall ensure that 
records for drugs dispensed from the pharmacy 
shall be maintained in the pharmacy. Records of 
drugs administered to patients shall be maintained 
in the medical record of the patient. 

(d) Verbal orders for drugs shall be subject to 
medical staff policies. 

Statutory Authority G.S. 131E-79. 

.45 1 1 MEDICATION ADMINISTRATION 

(a) A facility shall have policies and procedures 
governing the administration of medications which 
shall be enforced and implemented by 
administration and staff. Policies and procedures 
shall include, but shall not necessarily be limited 
to: 

(1) accountability of controlled substances 
as defined by the G.S. 90, Article 5; 
and 

(2) dispensing and administering behavior 



modifying drugs, and psychotherapeutic;. 



agents; insulin; intravenous fluids and 
medications; cardiovascular drugs: 
antibiotics; and cytotoxic and related 
agents. 
(b) Nursing staff are responsible for ensuring 



that all medications or drugs and treatments are 
administered and discontinued in accordance with 
signed physician's orders which are recorded in 
the patient's medical record. 

(c) The governing body shall ensure that the 
facility's bylaws and operational policies clearly 
describe the categories of staff that are privileged 



to administer medications. These policies shall be 



in agreement with current rules of North Carolina 



Occupational Boards for each category of staff. 

(d) Medications shall be scheduled and 
administered according to the established policies 
of the facility. 

(e) Variances to the medication administration 



policy shall be reviewed and evaluated by the 
nurse executive or her designee. 

(f) The person administering medications shall 
identify each patient in accordance with the 
facility's policies and procedures prior to 
administering any medication. 

(g) Medication administered to a patient shall be 



recorded in the patient's medication administration 
record immediately after administration in 
accordance with the facility's policies and 
procedures. 

(h) Omission of medication and the reason for 
the omission shall be indicated in the patient's 
medical record. 

(i) The person administering medications which 
are ordered to be given as needed (PRN) shall 
justify the need for the same in the patient's 
medical record. 

{]} Medication administration records shall 
provide identification of the drug and strength of 
drug, quantity of drug administered, route 
administered, name and title of person 
administering the medication, and time and date of 
administration. 

(TO Self-administration of medications shall be 
permitted only if prescribed by the medical staff- 
Directions must be printed on the container. 

(1) The administration of one patient's 
medications to another patient is prohibited except 
in the case of an emergency. In the event of such 
as emergency, steps shall be taken by a pharmacist 
to ensure that the borrowed medications shall be 
replaced and so documented. 

(m) Verbal orders shall be countersigned jn 
accordance with Rule .3707(e) of this Subchapter. 



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9:21 



PROPOSED RULES 



Statutory Authority G.S. 131E-79. 

.4512 MEDICATIONS DISPENSED 

(a) The pharmacy shall dispense only those 
drugs which are listed in one or more of the 
references listed in Paragraph (b) of this Rule or as 
provided in Paragraph (c) of this Rule. Any drug 
unfavorably evaluated in any of these references 
shall be used only in accordance with standards 
established by. the facility's pharmacy committee. 

(b) References: 



m 
m 

£3} 
£41 

£5} 



United States Pharmacopoeia; 

National Drug Formulary; 

Evaluations of Drug Interactions by the 

American Pharmaceutical Association; 

American Hospital Formulary Service; 

and 

Other references approved by the 



Pharmacy Committee. 
Any drug approved for use as an 
investigational drug or otherwise by the U.S. Food 
and Drug Administration but not listed in 
Paragraph (b) of this Rule may be used in 
accordance with standards established by the 
facility's pharmacy committee, or its equivalent 
and a pproved by the U.S. Food and Drug 
Administration. Dockets Management Branch. 
FDS. Room 4062. 5600 Fishers Lane. Rockfield. 
Maryland 20857, at a cost dependent on the 
material requested. 



.4514 EMERGENCY PHARMACEUTICAL 
SERVICES 

Provision shall be made for emergency 
pharmaceutical services as currently described in 
the Pharmacy Laws of North Carolina. 

Statutory Authority G. S. 131E-79. 

.4515 DISPOSITION 

The director of pharmacy shall ensure that drugs, 
and pharmaceutical devices throughout the facility 
which are outdated, visibly deteriorated, unlabeled, 
inadequately labeled, recalled, discontinued or 
obsolete shall be identified by a pharmacist and 
shall be disposed of in compliance with applicable 
state and federal laws and regulations. 

Statutory Authority G.S. 131E-79. 

.4516 COMMERCIAL PHARMACEUTICAL 
SERVICE 

A facility using an outside pharmacist or 
pharmaceutical service must have a contract with 
that pharmacist or service. As part of the 
contract, the pharmacist or service shall be 
required to maintain at least the standards for 
operation of the pharmaceutical services outlined 
in this Subchapter. 

Statutory Authority G.S. 131E-79. 



Statutory Authority G.S. 131E-79. 

.4513 DRUG DISTRIBUTION SYSTEMS 

(a) The pharmacy committee shall develop 
written policies and procedures pertaining to the 
intra-facility drug distribution system. In 
developing such policies the committee shall utilize 
representatives of other disciplines within the 
facility, including nursing services. 

(b) The label of each patient's individual 
medication container shall bear all information 
required by the Pharmacy Laws of North Carolina. 

£c] The pharmacist, with the advice and 
guidance of the pharmacy committee or its 
equivalent, shall be responsible for specifications 
as to quality, quantity and source of supplies of all 
drugs. 

(d) There shall be a formulary or list of drugs 
accepted for use in the facility which shall be 
developed and amended as necessary by the 
pharmacy committee. 

Statutory Authority G.S. 131E-79. 



SECTION .4600 - SURGICAL 
AND ANESTHESIA SERVICES 

.4601 ORGANIZATION 

(a) The governing body shall approve the types 
of surgery and types of anesthesia services to be 
available throughout the hospital consistent with 
identified needs and resources. 

(b) Facility management shall assure that 
surgical or anesthesia procedures are performed 
only when the necessary equipment and personnel 
are available. 

(c) A facility that provides surgical or obstetric 
services shall provide anesthesia services on a 24- 
hour basis. 

£d) Facility management shall ensure that 
requirements and standards identified in this 
section a pply when any patient, in any setting, 
receives for any purpose, by any route: 

(1) general, spinal or other major regional 
anesthesia; or 

(2) sedation or analgesia that may result in 
the loss of protective reflexes; or 

(3) surgery or other invasive procedure 



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February 1, 1995 



1799 



PROPOSED RULES 



while receiving such anesthesia. 

Statutory Authority G.S. 131E-79. 

.4602 DIRECTOR OF SURGICAL 
SERVICES 

(a) Facility management shall assure that each 
department or service providing surgical services 
be directed by members of the medical staff whose 
clinical and administrative privileges have been 
approved by the governing body, 

(b) The medical staff shall ensure a system for 
monitoring and evaluating the quality and 
appropriateness of the care and treatment of 
surgical patients, and for monitoring the clinical 
performance of all individuals with clinical 
privileges. 

(c) In facilities where there is no anesthesiologist 
on staff the facility management shall: 

(1) with review of the medical staff, 
establish a consultation agreement with 
a board-certified or board-eligible 
anesthesiologist for the purpose of 
establishing policies and procedures for 
anesthesia safety and policies that relate 
to the administration of anesthesia in all 
departments or services of the facility; 
assume the responsibility for 
establishing general policies for 
anesthesia services: and 
establish a line of communication and 
supervision for staff. 



12) 



OJ 



Statutory Authority G.S. 131E-79. 

.4603 SURGICAL AND ANESTHESIA 
STAFF 

(a) Facility management shall develop processes 
to ensure that each individual provides only those 
services for which proof of licensure and 
competency can be demonstrated. 

(b) Facility management shall ensure: 

(1) when anesthesia is administered, a 



ill 



01 



qualified physician is immediately 
available in the facility to provide care 
in the event of a medical emergency; 
a roster of practitioners with a 
delineation of current surgical and 
anesthesia privileges is a vailable and 
maintained for the service; 
an on-call schedule of surgeons with 
privileges to be available at all times 
for emergency surgery and for post- 
operative clinical management is 
maintained; 



14} 



01 



the operating room is supervised by a 
qualified registered nurse or doctor of 
medicine or osteopathy; and 
an operating room register which shall 
include date of the operation, name and 
patient identification number, names of 
surgeons and surgical assistants, name 
of anesthetists, type of anesthesia given. 



pre- and post-operative diagnosis, type 
and duration of surgical procedure, and 
the presence or absence of 
complications in surgery is maintained. 



Statutory Authority G.S. 131E-79. 

.4604 DHtECTION OF ANESTHESIA 
SERVICES 

(a) Facility management shall ensure that 
anesthesia care be organized, directed and 
integrated with other related services or 
departments of the facility. 

(b) The department of anesthesia shall be 
responsible for ensuring that all anesthetics are 
administered as established in the medical staff 
rules. In facilities where there is no department of 
anesthesia, the medical staff shall assume the 
responsibility for establishing general policies and 
for supervising the administration of anesthetics. 

(c) Facility management shall ensure that 
anesthesi a services be directed by a member, or 
members, of the medical staff whose 



responsibilities shall be approved by the governing 
body and shall include: 

(1) establishment of criteria and procedures 
for the evaluation of the quality of all 
anesthesia care rendered; 

(2) review of clinical privileges for all 
licensed practitioners whose primary 
clinical activity is the provision of 
anesthesia services; and 

(3) establishment of written policies and 
procedures for anesthesia services. 

Statutory Authority G.S. 131E-79. 

.4605 POLICIES AND PROCEDURES 

(a) The director of surgical services shall 
develop policies and procedures for surgical and 
anesthesia services which shall be available to the 
medical, surgical, anesthesia staff and nursing 
personnel. 

(b) Facility management shall ensure that 
policies on anesthesia procedures include the 
delineation of pre-anesthesia and post-anesthesia 
responsibilities. 



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PROPOSED RULES 



(c) Facility management shall ensure that the 
policies listed below are followed for each patient: 

(1) a complete history and physical 
documented in the chart of every 
patient prior to surgery, including 
clinical indications for the surgical 
procedure; 

(2) an informed consent, in the patient's 
chart before surgery; 

(3) an evaluation of the patient and 
anesthesia planned, documented 
according to medical staff bylaws by an 
individual qualified to administer 
anesthesia services. Re-evaluation of 
the patient immediately prior to the 
induction of anesthesia shall be 
performed prior to surgery; 

(4) an operative report describing 
techniques, findings, tissue removed or 
altered, and pre and post-surgical 
diagnosis. This report must be written 
or dictated following surgery and 
signed by the surgeon in compliance 
with medical staff rules; 

(5) an intraoperative anesthesia record 
including the dosage of al] drugs and 
agents used, the duration of anesthesia, 
and the type and amount of all fluids or 
blood and blood products administered 
shall be documented; 

(6) evaluation and documentation of the 
postoperative status of the patient on 
admission to and discharge from the 
post-anesthesia recovery area; and 

(7) procedure to follow in the event that 
informed consent cannot be obtained. 

(d) The director of anesthesia services shall 
establish and apply criteria for discharge to 
determine the readiness of the patient for 
discharge. 

(1) The facility shall ensure that a 
physician or CRNA with appropriate 
clinical privileges be responsible for the 
decision to discharge a patient from a 
post-anesthesia recovery area; 

(2) With respect to outpatients, the hospital 
shall insure that a post-anesthesia 
evaluation be performed in accordance 
with policies and procedures approved 
by the medical staff. 

(e) Facility management shall establish 
regulations governing visitors and traffic control. 

Statutory Authority G. S. 131E-79. 



.4701 

The 



SECTION .4700 - NUTRITION 
AND DIETETIC SERVICES 

PROVISION OF SERVICES 

nutrition and dietetic services shall 



be 



organized, directed, staffed and integrated with 
other facility departments to provide optimal 
nutritional therapy and quality food service to 
patients. Nutrition therapy shall a pply the 
principles of the science of nutrition and be 
administered in accordance with the law and rules 
including but not limited to G.S. 90, Article 25. 

Statutory Authority G.S. 131E-79. 

.4702 ORGANIZATION 

(a) The nutrition and dietetic services shall be 
under the full-time direction of a person who is 
trained or experienced in food services 
administration and therapeutic diets. The director 
shall be one of the following: 

(1) A qualified dietitian; 

(2) An individual who possesses at least the 
following minimum qualifications: 

(A) Bachelor's degree in Foods and 
Nutrition or Food Service 
Management; 

(B) Dietetic Technician Registered 
(DTR); or 

(C) Certified Dietary Manager (CDM); or 

(3) An individual who is enrolled in a 
program to complete the minimum 
qualifications i n Paragraph 
(a)(lH2)(A)(B)(C) of this Rule. 

(b) The nutrition and dietetic services of the 
facility shall have at least one dietitian either full- 
time, part-time, or as consultant. The 
qualifications of the dietitian shall be included in 
the personnel files. If the director of nutrition and 
dietetic services is not a registered dietitian, there 
shall be an established method of communication 
between the director and the dietitian which 
ensures that the dietitian supervises the nutritional 
aspects of patient care and ensures that quality 
nutritional care is provided to patients. Dietitians 
or qualified designees shall attend and participate 
in meetings relevant to patient nutritional care, 
including but not limited to patient care 
conferences and discharge planning. 

(c) When a dietitian serves only in a consultant 
capacity, the facility management shall have a 
written contract with the individual which shall 
clearly define the responsibilities which includes 
the submission of written reports to the hospital 
administrator and the director of the nutrition and 



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February 1, 1995 



1801 



PROPOSED RULES 



dietetic services describing the extent and quality 
of the services provided. Frequency of visits of 
the consultant dietitian shall be defined in the 
contract. The consultant dietitian shall provide, on 
site, no less than eight hours of service every two 
weeks to provide the nutritional aspects of patient 
care including but not limited to the following: 

(1) approval of regular and modified 
menus, including standardized recipes; 

(2) performance of nutritional assessments; 

(3) development of nutrition care plans; 

(4) provision of nutrition therapy; 

(5) participation in development of policies 
and procedures; and 

(6) monitoring and evaluation of the 
effectiveness and appropriateness of 
nutrition and dietetic services. 

(d) Facility management shall ensure that there 
are written policies and procedures to govern all 
nutrition and dietetic service activities. These 
policies shall be developed by the nutrition and 
dietetic services in cooperation with personnel 
from other departments or services which are 
involved with nutrition and dietetic services and 
they shall be reviewed at least every three years, 
revised as necessary, and dated to indicate the time 
of last review. Administrative policies and 
procedures concerning food procurement, 
preparation, and service shall be written by the 
director of the nutrition and dietetic services. 
Nutritional care policies and procedures shall be 
written by the qualified dietitian. The nutrition 
and dietetic service policies and procedures shall 
include, but not be limited to the following: 

(1) provision of food and nutrition therapy 
prescriptions/orders; 

(2) development, approval and provision of 
regular and modified menus, including 
standardized recipes; 

(3) food purchasing, storage, inventory, 
preparation and service; 

(4) identification system designed to ensure 
that each patient receives appropriate 
diet as ordered; 

(5) ancillary dietetic services, as 
appropriate, including food storage and 
kitchens on patient care units, formula 
supply, cafeterias, vending operations 
and ice making; 

(6) preparation, storage, distribution, and 
administration of enteral nutrition 
programs; 

(7) assessment and monitoring of patients 
receiving enteral and total parenteral 
nutrition; 



£§1 
£91 



(10) 



personal hygiene and health of dietetic 

personnel; 

infection control measures to minimize 

the possibility of contamination and 

transfer of infection, including 

establishment of monitoring procedure 

to ensure that personnel are free from 

communicable infections and open skin 

lesions; and 

pertinent safety practices, including 

control of electrica l, flammable- 



mechanical, and radiation hazards. 

(e) Nutrition and dietetic services shall be 
provided by qualified personnel under supervision 
to meet needs of patients. The director of the 
nutrition and dietetic services shall ensure that 
personnel assigned to the department perform all 
functions necessary to meet the nutritional needs of 
patients. The director or qualified designee shall 
attend and participate in meetings, including that 
of department heads, and function as an integral 
member of the facility. 

(f) A facility which has a contract with an 
outside food management service, shall require as 
a part of the contract that the company complies 
with all applicable requirements and standards 



outlined in Section .4700 of this Subchapter for 
such service. The contract shall be available for 
review by the Division. 

Statutory Authority G.S. 131E-79. 

.4703 SANITATION AND SAFETY 

(a) The nutrition and dietetic service shall 
maintain a Grade A sanitation rating and comply 



with current laws and rules for sanitation as 
promulgated by the Commission for Health 
Services. The facilities and equipment of the 
nutrition and dietetic services shall be in 
compliance with applicable sanitation and safety 
laws and rules. 15A NCAC 18A .1300 
incorporated by reference including subsequent 
amendments and additions. Copies of 15A NCAC 
18A .1300 may be obtained at no charge from the 
Environmental Health Section, Health Division, 
N.C. Department of Environment, Health and 
Natural Resources, P.O. Box 27687, Raleigh, NC 
27611-7687. 

(b) Sufficient space and equipment shall be 
provided for the nutrition and dietetic services to 
accomplish the following: 

(1) store food and nonfood supplies under 
sanitary and secure conditions; 

(2) store food separately from nonfood 
su pplies. When storage facilities are 



1802 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



limited, paper products may be stored 
with food supplies; 

(3) prepare and distribute food, including 
therapeutic diets; 

(4) clean and sanitize utensils and dishes 
apart from food preparation areas; and 

(5) allow personnel to perform their duties, 
(c) Cleaning schedules and instructions for 

cleaning all equipment and work and storage areas 
shall be posted and followed in the nutrition and 
dietetic services area and accessible to aH nutrition 
and dietetics staff. Procedures for cleaning all 
equipment and work areas shall be followed 
consistently and documented to safeguard the 
health of the patient. 

Statutory Authority G.S. 131E-79. 

.4704 DISTRIBUTION OF FOOD 

Foods being displayed or transported shall be 
protected from contamination and spoilage in clean 
containers, and cabinets, or serving c arts. The 
food temperatures at the serving time shall be 
within the following acceptable ranges: 

(1) Hot liquids - 150 degrees (minimum); 

(2) Hot Cereal - 150 degrees (minimum); 

(3) Soups - 130 degrees (minimum); 

(4) Hot foods - 110 degrees (minimum); 

(5) Cold liquids - 50 degrees (maximum); 

(6) Cold foods ; 65 degrees (maximum). 

Statutory Authority G.S. 131E-79. 

.4705 NUTRITIONAL SUPPORT 

(a) The administration of the nutritional support 
shall be directed by a qualified dietitian. 
Observations and information pertinent to nutrition 
therapy shall be documented in the medical record 
of the patient. 

(b) The facility shall have a current nutrition 
care manual accessible to hospital personnel. The 
nutrition care manual shall be reviewed every three 
years, revised as necessary by a qualified dietitian, 
and approved jointly by the nutrition service and 
medical staff. 

(c) Therapeutic diets and enteral and parenteral 
nutrition therapy shall be prescribed in written 
orders on the medical records and provided as 
ordered. 

(d) The nutrition care manual shall reflect the 
standards for nutrition care that are at least in 
accordance with those referenced in the most 
current edition of "Recommended Dietary 
Allowance" of the Food and Nutrition Board of the 
National Research Council of the National 



Academy of Sciences. These standards include 
any subsequent amendments and editions of the 
referenced material and are available from the 
Office of Publications, National Academy Press, 
2101 Constitution Avenue, N.W., Washington, 
D.C. 20418 at a cost of six dollars ($6.00) per 
copy. The nutrition deficiencies of any modified 
diet that is not in compliance with the 
recommended dietary allowances shall be specified 
in the nutrition care manual. 

(e) The qualified dietitian shall be responsible 
for the development of a nutritional care plan in 
compliance with physician's orders to meet the 
nutritional needs of the patient. The nutrition care 
plan shall be included in the medical record of the 
patient on his discharge plan and transfer orders to 
the extent necessary for continuity of care. 
Facilities with long term care units shall have at 
least a three week menu cycle in the long term 
care units. 

Statutory Authority G.S. 131E-79. 

SECTION .4800 - DIAGNOSTIC 
IMAGING 

.4801 ORGANIZATION 

(a) Imaging services shall be under the 
supervision of a full-time radiologist, consulting 
radiologist, or a physician experienced in the 
particular imaging modality and the physician ]n 
charge must have the credentials required by 
facility policies. 

(b) Activities of the imaging service may include 
radio-therapy. 

(c) All imaging equipment shall be operated 
under professional supervision by qualified 
personnel trained in the use of imaging equipment 
and knowledgeable of safety precautions required 
by the North Carolina Department of 
Environment, Health and Natural Resources, 
Division of Radiation Protection. Copies of 
regulations are available from the N.C. 
Department of Environment Health and Natural 
Resources, Division of Radiation Proection, P.O. 
Box 27687, Raleigh, NC 2761 1-7687 at a cost of 
sixteen dollars ($16.00) each. 

Statutory Authority G.S. 131E-79. 

.4802 RECORDS 

(a) A documented record on each imaging 
examination shall be included in the patient's 
medical record. 

fb) Imaging reports shall be signed by the 



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NORTH CAROLINA REGISTER 



February 1, 1995 



1803 



PROPOSED RULES 



physician interpreting the study. 

(c) Copies of current reports made by_ private 
physicists or governing authority surveying the 
radiographic facilities shall be available to the 
Division. 

Statutory Authority G.S. 131E-79. 

.4803 STAFFING 

(a) The staffing of the imaging department shall 
be determined by the radiologist in charge or by 
another person designated by hospital management. 

(b) There shall be a minimum of one radiologic 
technologist available to the department on at least 
an on-call basis. 

Statutory Authority G.S. 131E-79. 



MONITORING RADIATION 
EXPOSURE OF PERSONNEL 

Facility management shall establish 



.4804 

(a) 

procedures for the monitoring of personnel and 
shall maintain a record for each individual working 
in the area of radiation where there is a reasonable 
probability of receiving one-fourth of the 
maximum permissible dose. 

(b) Records documenting the monitoring of 
personnel receiving radiation exposure through the 
use of film badges or dosimeters must also be 
maintained by facility management. Readings 
from badges or dosimeters shall be recorded on at 
least a monthly basis. 

(c) Upon termination of employment, each 
employee shall be provided with a summary of his 
exposure record. 

(d) Permanent records of radiological exposure 
on all monitored personnel shall be maintained for 
review by the Division. 

Statutory Authority G.S. 131E-79. 

.4805 SAFETY 

(a) Facility management shall ensure that all 
imaging equipment is operated under the 
supervision of a physician and by qualified 
personnel. 

(b) Facility management shall ensure that proper 
caution is exercised to protect all persons from 
exposure to radiation. 

(c) Safety inspections of the imaging 
department, including equipment, shall be 
conducted by the North Carolina Division of 
Radiation Protection Services. Copies of the 
report shall be available for review by the 
Division. 



(d) The governing authority shall appoint a 
radiation safety committee. The committee shall 
include but is not limited to: 

(1) a physician experienced in the handlin; 
of radio-active isotopes and their 
therapeutic use; and 

(2) other representatives of the medical 
staff. 

(e) All radio-active isotopes, whether for 
diagnostic, therapeutic, or research purposes shall 
be received, handled, and disposed of in 
accordance with the requirements of the North 



Carolina Department of Environment. Health, and 
Natural Resources. Division of Radiation 
Protection. Copies of regulations are available 
North Carolina Department of 
Health, and Natural Resources 



from the 

Environment 

Division of Radiation Protection. P.O. Box 27687. 



Raleigh. NC 27611-7687 at a cost of six dollars 
($6.00) each. 

Statutory Authority G.S. 131E-79. 

.4806 NUCLEAR MEDICINE SERVICES 

When nuclear medicine services are offered, the 



governing board shall adopt written policies and 
procedures for the provision of those services 



which will ensure safety of patients and staff, 



management of radioactive isotopes and the 
maintenance of equipment according to the 
manufacturers' recommendations. 

Statutory Authority G.S. 131E-79. 

SECTION .4900 - LABORATORY 
SERVICES AND PATHOLOGY 

.4901 ORGANIZATION 

The laboratory shall be under the supervision of 
a clinical pathologist or physician designated by. 
the governing board, who has special training in 
clinical laboratory diagnosis. 

Statutory Authority G.S. 131E-79. 

.4902 RECORDS 

(a) All requests for laboratory services shall be 
documented. 

(b) All reports of laboratory services performed, 
including autopsy, shall be placed in the patient's 
medical record. 

(c) Records of proficiency testing appropriate to 
the scope of services offered shall be available to 
the Division for review. 

(d) Records of equipment calibration and quality 



1804 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



controls as recommended by the manufacturer shall 
be maintained and be available to the Division for 
review. 

Statutory Authority G.S. 131E-79. 

.4903 STAFFING 

The clinical pathologist or his appointed 
designee, shall ensure that: 

(1) procedures and tests conducted are within 
the scope of the laboratory as approved 
by. the hospital; 

(2) at least one qualified medical technologist 
is available at all times; and 

(3) qualified staff are available to carry out 
the functions of the laboratory. 

Statutory Authority G.S. 131E-79. 

.4904 TESTS 

(a) Laboratory tests to be performed on a patient 
at the time of admission (if any) shall be 
established by the medical staff and be approved 
by the governing board of the hospital. In the 
event the medical staff and governing board elect 
not to establish routine laboratory tests for new 
admissions, the request for such tests shall be left 
to the discretion of the admitting physician. 

(b) Serological tests for patients admitted shall 
be optional with the hospital. However, there 
shall be adequate records indicating that obstetrical 
patients have had a serological test during their 
current pregnancy. 

(c) When laboratories outside of the facility are 
used, such laboratories must be a pproved by the 
governing board and medical staff of the facility. 
In case of such usage, a legible copy of the 
laboratory report must be included in the patient 
record. 

Statutory Authority G.S. 131E-79. 

.4905 TISSUE REMOVAL AND DISPOSAL 

(a) The medical staff shall adopt written policies 
for pathological examination of tissue and 
specimens removed during surgery. 

(b) Pathological waste disposal must comply 
with the rules Governing the Sanitation of 
Hospitals. Nursing and Rest Homes. Sanitariums. 
Sanatoriums. and Educational and Other 
Institutions, contained in 15A NCAC 18A .1300 
which is hereby incorporated by reference 
including subsequent amendments and editions- 
Copies of 15A NCAC 18A .1300 may be obtained 
at no charge from the Environmental Health 



Section. Health Division. North Carolina 
Department of Environment. Health and Natural 
Resources. P.O. Box 27687. Raleigh. NC 27611- 
7687. 



Statutory Authority G.S. 131E-79. 

.4906 BLOOD BANK 

(a) Facilities which provide for procurement, 
storage and transfusion of blood shall meet the 
standards of the American Association of Blood 
Banks as outlined in the most current edition of 
Standards of Blood Banks and Transfusion 
Services available from the American Association 
of Blood Banks. 8101 Glenbrook Road. Bethesda. 
Maryland 20814-2749 at a cost of thirty-three 
dollars and fifty cents ($33.50) per copy. 

(b) The governing body shall ap prove the 
pathologist or physician as physician-in-charge of 
the blood bank service. 

(c) Records shall be kept on file indicating the 
receipt and disposition of all blood handled. Care 
shall be taken to ascertain that blood administered 
has not exceeded its expiration date, and meets all 
criteria for safe administration. 

(d) The facility shall make arrangements to 
secure on short notice all necessary supplies of 
blood, typed and cross-matched as required, for 
emergencies. 

Statutory Authority G.S. 131E-79. 



MORGUE AND AUTOPSY 
FACELmES 

Morgue and autopsy services shall 



.4907 

(a) Morgue and autopsy services shall be 
provided either on site or by written agreement 
with a facility that provides those services. 

(b) Procedures for the transport and storage of 
deceased patients shall be adopted by facility 
management. 

(c) Procedures for post mortem cleaning of 
patients with diagnosed contagious diseases shall 
be adopted by the facility management. 

Statutory Authority G.S. 131E-79. 

SECTION .5000 - PHYSICAL 
REHABILITATION SERVICES 

.5001 ORGANIZATION 

Facility management shall designate an individual 
responsible for the administration and supervision 
of each rehabilitation service. 

Statutory Authority G.S. 131E-79. 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1805 



PROPOSED RULES 



.5002 DELIVERY OF CARE 

(a) A member of the medical staff shall be 
responsible for the general medical care of the 
patient. 

(~b) The delivery of all rehabilitation services 
shall be provided by practitione rs credential ed or 
licensed in their respective fields. 

Statutory Authority G.S. 131E-79. 

.5003 POLICIES AND PROCEDURES 

Facility management shall establish written 
policies and procedures that include but are not 
limited to: 
(1) provision for assessment and evaluation 
of the services performed; 
safety measures; 
infection control measures; and 



121 

141 



procedures for referral to other facilities 
for services not available on site. 



Statutory Authority G.S. 131E-79. 

.5004 PATIENT RECORDS 

The patient record shall contain documentation of 
physical rehabilitation services utilized that include 
but is not limited to: 
(1) diagnosis to support the services 
requested; 

assessment of patient's rehabilitative 
status; 



Oi 
0} 
141 
(51 



re-assessment and progress of patient's 

rehabilitative status; 

individualized plan of care and goals of 

rehabilitation; and 

discharge plan. 



Statutory Authority G.S. 131E-79. 

.5005 CARDIAC REHABILITATION 
PROGRAM 

When a facility elects to provide an outpatient 
cardiac rehabilitation program, the program shall 
be subject to rules K) NCAC 3S. Section .0300- 
.1000 adopted by reference with all subsequent 
amendments. Referenced rules are available from 
the North Carolina Department of Human 
Resources. Division of Facility Services. Medical 
Facilities Licensure Section. 701 Barbour Drive. 
Raleigh. NC 27603 at a cost of three dollars 
($3.00) each. 

Statutory Authority G.S. 131E-79. 

SECTION .5100 - INFECTION CONTROL 



.5101 ORGANIZATION 

(a) The governing body shall establish an 
infection control program that includes all patient 
care and patient care support services and 
departments for the surveillance, prevention and 
control of infection. 

Co) The infection control committee shall include 



representatives of the medical staff, nursing staff, 
administration and the person directly responsible 
for the surveillance program activities. 
(c) The infection control committee shall assume 



responsibility for the infection control program. 

(d) Facility management shall designate a person 
to manage the infection control, prevention and 
surveillance program. 

(e) The infection control committee shall involve 
facility departments and services as needed to 
maintain the infection control program. 

Statutory Authority G.S. 131E-79. 

.5102 POLICY AND PROCEDURES 

(a) Each facility department or service shall 
establish written infection control policies and 
procedures. These shall include but are not 
limited to: 

(1) the role and scope of the service or 
department in the infection control 
program; 

(2) the role and scope of surveillance 
activities in the infection control 
program; 

(3) the methodology used to collect and 
analyze data, maintain a surveillance 
program on nosocomial infection, and 
the control and prevention of infection; 

(4) the specific precautions to be used to 
prevent the transmission of infection 
and isolation methods to be utilized; 

(5) the method of sterilization and storage 
of equipment and supplies, including 
the reprocessing of disposable items; 

(6) the cleaning of patient care areas and 
equipment; 

(71 the cleaning of non-patient care areas; 

and 
(8) exposure control plans. 

(b) The infection control committee shall 
approve all infection control policies and 
procedures. The committee shall review all 
policies and procedures at least every three years 
and indicate the last date of review. 

(c) The infection control committee shall meet at 
least quarterly and maintain minutes of meetings. 



1806 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



Statutory Authority G.S. 131E-79. 

.5103 LAUNDRY SERVICE 

Facility management shall provide, directly or by 
contract, a laundry service or department that 
achieves the following: 

(1) 24 hour a day availability of clean linen 
for patient care needs; and 

(2) delivery of clean linen and removal of 
soiled linen in a manner that reduces the 
spread of infection. 

Statutory Authority G.S. 131E-79. 

.5104 ENVIRONMENTAL SERVICES 

Facility management shall ensure that 
environmental services (housekeeping) achieve the 
following: 

(1) 24 hour a day availability of personnel or 
supplies and equipment for the cleaning 
of patient rooms, patient care equipment, 
and the cleaning of spills; 

(2) a routine cleaning schedule for all areas 
of the facility to assist in the prevention 
and spread of disease; and 

(3) removal and appropriate disposal of 
waste materials including biologicals. 

Statutory Authority G.S. 131E-79. 

.5105 STERILE SUPPLY SERVICES 

Facility management shall ensure that services 
achieve the following: 

(1) decontamination and sterilization of 
equipment and supplies; 

(2) monitoring of sterilizing equipment on a 
routine schedule; 

(3) policies and procedures for the reuse of 
disposable items; and 

(4) policies and procedures addressing shelf 
life of stored sterile items. 

Statutory Authority G.S. 131E-79. 

SECTION .5200 - PSYCHIATRIC 
SERVICES 

.5201 PSYCHIATRIC OR SUBSTANCE 

ABUSE SERVICES: APPLICABILITY 
OF RULES 

The rules contained in this Section shall apply to 
all psychiatric and substance abuse services 
provided. 

Statutory Authority G.S. 131E-79. 



.5202 DEFINITIONS APPLICABLE TO 
PSYCHIATRIC OR SUBSTANCE 
ABUSE SERVICES 

(a) "Certified counselor" means an alcoholism, 
drug abuse or substance abuse counselor who is 
certified by the North Carolina Substance Abuse 
Professional Certification Board. 

(b) " Certified substance abuse 
counselor/supervisor" means an individual who is 
a "certified counselor" as defined in 10 NCAC 3C 
.5202(a) and is designated by the North Carolina 
Substance Abuse Professional Certification Board 
as a qualified substance abuse supervisor. 

(c) "Clinical/professional supervision" means 
regularly scheduled assistance by a qualified 
mental health, professional or a qualified substance 
abuse professional to a staff member who is 
providing direct, therapeutic intervention to a 
client or clients. The purpose of clinical 
supervision is to ensure that each client receives 
appropriate treatment or habilitation which is 
consistent with accepted standards of practice and 
the needs of the client. 

(d) "Detoxification service" means a service 
provided in a unit or department whose primary 
purpose is to treat substance abuse through 
detoxification. 

(e) "Direct care staff" means an individual who 
provides active direct care, treatment, or 
rehabilitation or habilitation services to clients on 
a continuous and regularly scheduled basis. 

(f) "Psychiatric nurse" means an individual who 
is licensed to practice as a registered nurse, in 
North Carolina by the North Carolina Board of 
Nursing and who is a graduate of an accredited 
master's level program in psychiatric mental health 
nursing with two years of experience or has a 
master's degree in behavioral science with two 
years of supervised clinical experience in 
psychiatric mental health nursing or has four years 
of supervised clinical experience in psychiatric 
mental health nursing. 

(g) "Psychiatric service" means a service 
provided in a unit or department who primary 
purpose is to treat mental illness. 

(h) "Psychiatric social worker" means an 
individual who holds a master's degree in social 
work from an accredited school of social work and 
has two years of clinical social work experience. 

£i) "Psychiatrist" means an individual who is 
licensed to practice medicine in North Carolina 
and who has completed an accredited training 
program in psychiatry. 

(j) "Psychologist" means an individual licensed 
to practice psychology in North Carolina by the 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1807 



PROPOSED RULES 



North Carolina State Board of Examiners of 
Practicing Psychologists. 

(TO "Qualified mental health professional" means 
any one of the following: psychiatrist, psychiatric 
nurse, practicing psychologist, psychiatric social 
worker, an individual with at least a masters 
degree in a related human service field and two 
years of supervised clinical experience in mental 
health services or an individual with a 
baccalaureate degree in a related human service 
field and four years of supervised clinical 
experience in mental health services. 

£1] "Qualified substance abuse professional" 
means an individual who is: 

the North 
Abuse 



(1) certified by 



Carolina 



Professional 



Substance 
Certification Board; 

(2) certified by the National Consortium of 
Chemical Dependency Nurses, Inc; or 

(3) a graduate of a college or university 
with a baccalaureate or advanced 
degree in a human service related filed 
with documentation of at least two 
years of supervised experience in the 
profession of alcoholism and drug abuse 
counseling. 

(m) "Restraint" means the limitation of one's 
freedom of movement and includes the following: 

(1) mechanical restraint which means 
restraint of a client with the intent of 
controlling behavior with mechanical 
devices which include, but are not 
limited to, cuff, ankle straps, sheets or 
restraining shirts; or 

(2) physical restraint which means restraint 
of a client until calm. As used in these 
Rules, the term physical restraint does 
not apply to the use of professionally 
recognized methods for therapeutic 
holds of brief duration (five minutes or 
less). 

(n) "Restrictive facility" means a facility so 
designated by the Division which uses mechanical 
is proposed to be adopted as follows restraint or 
seclusion in accordance with G.S. 122C-60 in 
order to restrain a client's freedom of movement- 
Co) "Seclusion" means isolating a client in a 
separate locked room for the purpose of 



controlling a client's behavior, 
(p) "Substance abuse service" 



means service 



provided in a unit or department whose primary 
purpose is to treat substance abuse. 

Statutory Authority G.S. 131E-79. 



.5203 STAFFING FOR PSYCHIATRIC 

OR SUBSTANCE ABUSE SERVICES 

(a) General Requirements: 

(1) A physician shall be present in the 

facility or on call 24 hours per day. 

The medical appraisal and medical 



(21 



treatment of each patient shall be the 

responsibility of a physician; 

Each facility shall determine its overall 



staffing requirements based upon the 
age categories (child, adolescent, adult, 
elderly), clinical characteristics 



treatment requirements and numbers of 
patients; 

There shall be a sufficient number of 
appropriately qualified clinical and 
support staff to assess and address the 
clinical needs of the patients; 
Staff members shall have training or 
experience in the provision of care in 
each of the age categories assigned for 
treatment. 
(b) Psychiatric Services: 
(1) Staff coverage for psychiatric services 



£3} 



141 



shall include at least one each of the 
following: psychiatrist, psychiatric 



nurse, psychologist, and psychiatric 
social worker; 
(2) A qualified mental health professional 



£3] 



shall be available by telephone or page 
and able to reach the facility within 30 
minutes on a 24 hour basis; 
Each clinical or direct care staff 
member who is not a qualified mental 
health professional shall receive 



14} 



professional supervision from a 
qualified mental health professional; 
When detoxification services are 
provided, there shall be. liaison and 
consultation with a qualified substance 
abuse professional prior to the 
discharge of a client. 
(c) Substance Abuse Services: 
(1) At least one registered nurse shall be on 
duty during each shift; 



£2} 



Certified substance abuse counselors or 



qualified substance abuse professionals 



shall be employed at the ratio of one 
staff member for each 10 inpatients or 
fraction thereof. In documented 



instances of bona fide shortages of 
certified persons, uncertified individuals 



expecting to become certified may be 
employed for a maximum of 38 months 
without qualifications; 



1808 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



£3} 



(M 



The facility shall have a minimum of 

two staff members providing care, 

treatment and services directly to 

patients on duty at all times and 

maintain a shift ratio of one staff 

member for each 20 or less inpatients 

with the following exceptions: 

When there are minor inpatients there 

shall be staff available on the ratio of 

one staff member for each five minor 

inpatients or fraction thereof during 

each shift from 7:00 a.m. z 11:00 

p.m.; 



(B) When detox services are offered there 
shall be no less than one staff member 
for each nine inpatients or fraction 
thereof on each shift. 



Statutory Authority G.S. 131E-79. 

.5204 PSYCHIATRIC OR SUBSTANCE 
ABUSE SERVICES RECORD 
REQUIREMENTS 

(a) In addition to the general record keeping 
requirements of K) NCAC 3C .3906, specialized 
assessment and treatment plans for individuals 
undergoing psychiatric or substance abuse 
treatment are as follows: 

(1) Within 24 hours following admission 
each individual shall have a completed 
admission assessment. The initial 
assessment shall include the reason for 
admission, admitting diagnosis, mental 
status including suicide potential, 
diagnostic tests or evaluations, and a 
determination of the need for additional 
information to include the potential for 
the physical abuse of self or others and 
a family assessment when a minor is 
involved; 

(2) Within 72 hours following admission, a 
preliminary individual treatment plan 
shall be completed and implemented; 
and 

(3) Within ten days following admission, a 
comprehensive individual treatment 
plan shall be developed and 
implemented. For outpatient programs 
the plan shall be developed and 
implemented within 30 days of 
admission to treatment. 

(b) Individual treatment plans for psychiatric and 
substance abuse patients shall be developed in 
partnership with the patient or individual acting on 
behalf of the patient. Clinical responsibility for 



the development and implementation of the plan 
shall be clearly designated. Minimum components 
of the comprehensive treatment plan shall include 
diagnosis and time specific short and long term 
measurable goals, strategies for reaching goals, 
and staff responsibility for plan implementation. 
The plan shall be revised as medically or clinically 
indicated. 

(c) Progress notes shall be entered in each 
individual's record. Included is information which 
may have a significant impact on the individual's 
condition or expected outcome such as family 
conferences or major events related to the patient. 
Patient status shall be documented each shift for 
any inpatient psychiatric or substance abuse 
services, and on a per visit basis for outpatient 
psychiatric and substance abuse services. 

(d) For each individual to whom substance abuse 
services are provided, a written plan for aftercare 
services shall be developed which minimally 
includes: 

plan for delivering aftercare services, 
including the aftercare services which 
are provided; and 

provision for agreements with 
individuals or organizations if aftercare 
services are not provided directly by 
the facility. 

Statutory Authority G.S. 131E-79. 

.5205 SECLUSION 

At least one seclusion room shall be provided in 
all hospitals licensed to provide a psychiatric 
program, a substance abuse program or both. 

Statutory Authority G.S. 131E-79. 

.5206 COMPLIANCE WITH 

STATUTORY REQUIREMENTS 

(a) Facilities providing psychiatric or substance 
abuse services shall develop procedures to ensure 
the rights of psychiatric and substance abuse 
patients in accordance with North Carolina statutes 
addressing the rights of psychiatric and substance 
abuse patients. Statutes addressing such rights are 
as follows: 

G.S. 122C-51. Declaration of policy 



ill 



m 



14) 
15} 



on clients' rights; 

G.S. 122C-52. Right to confidentiality; 

G.S. 122C-53. Exceptions; client; 

G.S. 122C-54. Exceptions: abuse 

reports and court proceedings; 

G.S. 122C-55. Exceptions; care and 

treatment; 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1809 



PROPOSED RULES 



£6) 

m 

(8) 
121 
(10) 

an 

(12) 
(13) 
(14) 



G.S. 122C-56. Exceptions; research 
and planning; 
G.S. 122C-57. 



Right to treatment and 
consent to treatment; 
G.S. 122C-58. Civil rights and civil 
remedies' 



G.S. 122C-59. Use of corporal 
punishment; 

G.S. 122C-60. Use of physical 
restraints or seclusion; 
G.S. 122C-61. Treatment rights in 24- 
hour facilities; 
G.S. 122C-62. 
hour facilities; 
G.S. 



Additional rights in 24- 
Offenses relating to 



_ 122C-65 
clients; and 

G.S. 122C-66. Protection from abuse 
and exploitation; reporting, 
fb) Facilities providing psychiatric or substance 
abuse services shall develop procedures to protect 
confidentiality of information regarding 
communicable disease and conditions in 
compliance with G.S. 130A-143. 

Statutory Authority G.S. 131E-79. 

.5207 PSYCHIATRIC OR SUBSTANCE 
ABUSE OUTPATIENT SERVICES 

Partial hospitalization, outpatient and day 
treatment facilities shall be subject to rules 10 
NCAC 14L .0300, 10 NCAC 14N .0700. and K) 
NCAC 14N .0900 respectively and adopted by 
reference with all subsequent amendments- 
Referenced rules are available from the N.C. 
Division of Mental Health, Developmental 
Disabilities, and Substance Abuse Services, 
Quality Improvement Section, 325 North Salisbury 
Street, Raleigh, NC 27603-5906 at a cost of five 
dollars and seventy -five cents ($5.75) per copy. 

Statutory Authority G.S. 131E-79. 

SECTION .5300 - SUPPLEMENTAL 

RULES FOR THE LICENSURE 

OF THE NURSING FACILITY 

BEDS; DOMICILIARY BEDS IN 

A HOSPITAL 

.5301 SUPPLEMENTAL RULES 

When a facility offers nursing facility services or 
domiciliary care services, the services shall be 
included under one hospital license as provided in 
Rule .3101 of this Subchapter. The nursing 
facility care and domiciliary care unit shall meet 
the supplemental requirements of this Section in 



addition to all other applicable rules in this 
Subchapter. 

Statutory Authority G.S. 131E-79. 

.5302 DEFINITIONS 

The following definitions shall apply throughout 
this Section: 



ID 



(a) 



M 



isl 



id] 



iSl 



Ql 



£31 



14} 



"Abuse" means the willful infliction of 
physical pain, injury, mental anguish oi 
unreasonable confinement which ma; 
result 



cause or 



in temporary or 
permanent mental or physical injury, 



pain, harm or death. Abuse includes, but 



is not limited to, the following: 
Verbal abuse ; any use of oral. written 
or gestured language which a 
reasonable person would view as 
disparaging and derogatory terms to a 
patient regardless of his or her age, 
ability to comprehend or disability; 
Sexual abuse sexual harassment 



sexual coercion or sexual assault of a 

patient: 

Physical abuse z hitting, sla pping. 



kicking or corporal punishment of a 

patient; 

Mental abuse - language or treatment 



which would be viewed by a reasonable 
person as involving humiliation, 
harassment, threats of punishment or 
deprivation of a patient; 
Unreasonable confinement ; the 
separation of a patient from other 
persons, or from his or her room 



against the patient's will or the will of 
the patient's legal representative. 
Unreasonable confinement does not 
include emergency or short-term 
monitored separation used as 
therapeutic intervention to reduce 
agitation until a plan of care is 
developed to meet the patient's needs. 
'Accident" means something occurring 



by chance or without intention which has 
caused physical or mental harm to a 
patient, resident or employee; 
"Administer" means the direct application 
of a drug to the body of a patient by 
injection, inhalation, ingestion or other 
means; 

"Administrator" means the person who 
has authority for and is responsible to the 
governing board for the overall operation 
of a nursing facility or domiciliary care 



1810 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



facility; 

(5) "Brain injury long term care" is defined 
as an inter-disciplinary, intensive 
maintenance program for patients who 
have incurred brain damage caused by 
external physical trauma and who have 
completed a primary course of 
rehabilitative treatment and have reached 
a point of no gain or progress for more 
than three consecutive months. Services 
are provided through a medically 
supervised interdisciplinary process and 
are directed toward maintaining the 
individual at the optimal level of 
physical. cognitive and behavioral 
functioning; 

(6) "Combination facility" means any facility 
with nursing facility beds (nursing home 
beds) which is licensed to provide more 
than one level of care; 

(7) "Convalescent care" means care given for 
the purpose of assisting the patient or 
resident to regain health or strength; 

(8) "Director of Nursing" means the 
registered nurse who has authority and 
direct responsibility for all nursing 
services and nursing care on the nursing 
facility; 

(9) "Dispense" means preparing and 
packaging a prescription drug or device 
in a container and labeling the container 
with information required by state and 
federal law. Filling or refilling drug 
containers with prescription drugs for 
subsequent use by a patient is 
"dispensing". Providing quantities of 
unit dose prescription drugs for 
subsequent administration i_s 
"dispensing"; 

(10) "Drug" or "medication" means 
substances: 

(a) recognized in the official United States 
Pharmacopoeia. official National 
Formulary, or any su pplement to any of 
them; 

(b) intended for use in the diagnosis, cure, 
mitigation, treatment, or prevention of 
disease in man or other animals; 

(c) intended to affect the structure or any 
function of the body of man or other 
animals, i.e.. substances other than 
food; and 

(d) intended for use as a component of any 
article specified in Paragraphs (a), (b). 
or £c) of this Subparagraph; but does 



not include devices or their 
components, parts, or accessories. 

(11) "Duly licensed" means holding a current 
and valid license as required under the 
General Statutes of North Carolina; 

(12) "Existing facility" means a licensed 
facility; 

(13) "Exit conference" means the conference 
held at the end of a survey, inspection or 
investigation, but prior to finalizing the 
same. between the department's 
representatives who conducted the 
survey, inspection or investigation and a 
facility's representati ve(s) ; 

(14) "Incident" means an intentional or 
unintentional action, occurrence or event 
which is likely to cause or lead to 
physical or mental harm to a patient, 
resident or employee; 

(15) "Licensed Practical Nurse" means a 
nurse who is duly licensed as a practical 
nurse under G.S. 90. Article 9A; 

(16) "Licensee" means the person, firm, 
partnership, association, corporation or 
organization to whom a license has been 
issued; 

(17) "Misappropriation of property" means the 
criminal taking, use, exploitation of, 
destruction of, or damage to, a patient's 
belongings or money. The Department 
must prove the misappropriation of 
property by a preponderance of the 
evidence. Conviction of the criminal act 
is not a prerequisite to placing a finding 
concerning the misappropriation of 
property on the North Carolina Nurse 
Aide Register/ : 

(18) "Neglect" means a failure through a lack 
of attention, carelessness, or omission, to 
provide timely and consistent services, 
treatment or care to a patient or patients 
which are necessary to obtain or maintain 
the patient's or patients' health, safety or 
comfort; 

(19) "New facility" means a proposed facility, 
a proposed addition to an existing facility 
or a proposed remodeled portion of an 
existing facility. Jf it is determined by the 
department that more than one half of an 
existing facility is remodeled, the entire 
existing facility shall be considered a new 
facility; 

(20) "Nurse Aide" means any individual 
providing nursing-related services to 
patients in a facility, who is not a 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1811 



PROPOSED RULES 



(21) 



(1T\ 



(23) 
(24) 

(25) 

(26) 
(27) 

(28) 

(29) 



licensed health professional, a registered 
dietitian or someone who volunteers to 
provide such services without pay, and 
who is listed on the North Carolina 
Nurse Aide registry; 
"Nurse Aide Trainee" means an 
individual who has not completed an 
approved nurse aide training course and 
competency evaluation but is performing 
tasks for which they have been found 
proficient by an instructor. These tasks 
shall be performed under the direct 
supervision of a registered nurse. The 
term does not apply to volunteers; 
"On duty" means personnel who are 
awake, dressed, responsive to patient 
needs and physically present in the 
facility performing assigned duties; 
"Patient" means any person admitted for 
care to a nursing facility; 
"Physician" means a person licensed 
under G.S. 90, Article 1 to practice 
medicine in North Carolina; 
"Registered Nurse" means a nurse who is 
duly licensed as a registered nurse under 
G.S. 90, Article 9A; 
"Resident" means any person admitted 
for care to a domiciliary home; 
"Restorative nursing care" means the 
plan and delivery of care to attain and 



maintain the patient's pre-illness level of 
fu nction; 

"Sitter" means an individual employed to 
provide companionship and social 
interaction to a particular resident or 
patient, usually on a private duty basis; 
"Ventilator dependence" is defined as 
physiological dependency by a patient on 
the use of a ventilator for more than eight 
hours a day. 



Statutory Authority G.S. 131E-79. 



.5303 INSPECTIONS 

(a) Any facility with beds licensed by the 
Department under this Section may be inspected by 
one or more authorized representative of the 
Division at any time. Generally, inspections will 
be conducted between the hours of 8:00 a.m. and 
6:00 p.m., Monday through Friday. However, 
complaint investigations shall be conducted at the 
most appropriate time for investigating the 
complaint. 

(b) At the time of inspection, the authorized 
representative of the Division shall make his 



presence known to the administrator or othj 
person in charge who shall cooperate with sue 
representative and facilitate the inspection. 



Statutory Authority G.S. 131E-79. 

.5304 ADMISSIONS 

(a) No patient or resident shall be admitted 
except under the orders of a North Carotin 



licensed physician, 
(b) The nursing facility shall acquire prior to q 



at the time of admission orders from the attendin 



physician for the immediate care of the patient o 
resident. 

(c) Within 48 hours of admission, the facilit 
shall acquire medical information which shal 
include current medical findings, diagnosis 
rehabilitation potential, a summary of the facilir; 



stay if the patient or resident is being transferra 



from a facility, and orders for the ongoing care o 

the patient or resident. 

(d) If a patient is admitted from somewhen 



other than a facility, a physical examination shal 
be performed either within five days prior to 
admission or within 48 hours following admission 
(e) Facilities offering nursing facility pj 
domiciliary home care as a new service mus 
prepare a plan of admission which, at a minimum 



ensures availability of staff time and plans foi 
individual patient assessments, initiation of healt l 



care or nursing care plans, and implementation a 
physician and nursing treatment plans. This plai 



shall be available for inspection during the initial 



licensure survey prior to issuance of a license. 

(f) Only persons who are 18 years of age or 
older shall be admitted to domiciliary home beds 



Statutory Authority G.S. 131E-79. 

.5305 POLICIES AND PROCEDURES 

The governing board shall ensure the 
development of written policies and procedures 
which shall be available to and implemented by 
staff. These policies and procedures shall cover at 
least the following areas: 
(1) admissions and transfers; 

discharges with physician orders and 
patients or residents leaving against 
physician advice; 
nutrition and dietetic services; 
gratuities and solicitation policies which 
at a minimum shall provide that no 
owner, operator, agent or employee of a 
facility nor any member of his famil 
shall accept a gratuity directly or 



Oi 



£3} 
14} 



1812 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



m 

£91 



indirectly from a patient or resident in 
the facility or solicit for any type of 
contribution; 

(5) housekeeping; 

(6) infection control which include, but not 
limited to. requirements for sterile, 
aseptic and isolation techniques; and 
communicable disease screening 
including, at a minimum annual 
tuberculosis screening for all staff and 
inpatients of the facility; 
screening and reporting communicable 
disease to the local health department; 
orientation of all facility personnel; 
patient or resident care plans, treatment 
and other health care or nursing care, 
including but not limited to all policies 
and procedures required by rules 
contained in this Subchapter; 

(10) patients' or residents' rights; 

(11) physical evaluation for residents and 
patients at least annually; 

(12) physician services and utilization of the 
individual's private physician; 

(13) procurement of supplies and equipment to 
meet individual patient care needs; 

(14) protection of patients from abuse and 
neglect; 

(15) rehabilitation services; 

(16) release of medical record information; 
and 

(17) maintenance of patient medical or health 
care records including charging or record 
keeping. 

Statutory Authority G.S. 131E-79. 

.5306 GENERAL 

The governing board shall ensure that policies 
and procedures are available and implemented for 
assessing each patient's or resident's health care 
needs and for planning to meet identified health 
care needs. There shall be a system for evaluating 
the effectiveness of the nursing care assessment, 
planning and implementation (delivery of care 
processes) for each patient or resident. 

Statutory Authority G.S. 131E-79. 

.5307 ASSESSMENT AND PLANNING 

Each patient's and resident's condition shall be 
assessed on a regular, periodic basis, at least 
quarterly, with a ppropriate notation and updating 
of the health plan of care. Health care planning 
for each patient and resident shall be an on-going 



interdisciplinary process and shall include, but not 
be limited to, the following: 

(1) data which is systematically and continu- 
ously collected about the patient's or 
resident's health status; and which shall 
be recorded so as to be accessible to all 
staff involved in the patient's or 
resident's care; 

(2) current problems or needs shall be identi- 
fied and prioritized from a completed 
assessment; and 

(3) a current plan of care developed in con- 
junction with the patient, resident or legal 
guardian that includes measurable time- 
related goals and approaches, or mea- 
sures to be employed by various disci- 
plines in order to achieve the identified 
goals. 

Statutory Authority G.S. 131E-79. 

.5308 IMPLEMENTATION OF HEALTH 
PLAN 

All parts of the plan of care shall be assigned to 
specific disciplines or staff as indicated in the plan 
of care to ensure that health care and rehabilitative 
services are performed daily and documented for 
those patients and residents who require such 
services. 

Statutory Authority G.S. 131E-79. 

.5309 NURSING/HEALTH CARE 
ADMINISTRATION AND 
SUPERVISION 

(a) A hospital nursing facility or unit shall have 
a director of nursing service who shall be responsi- 
ble for the overall organization and management of 
all nursing services. The director of nursing 
service shall be currently licensed to practice as a 
registered nurse by the North Carolina Board of 
Nursing in accordance with G.S. 90, Article 9A. 

(b) A facility or unit shall not be licensed unless 
it has a director of nursing or acting director or 
nursing. 

(c) The director of nursing shall not serve as 
administrator or assistant administrator. 

(d) A facility shall provide a full-time director 
of nursing on duty at least eight hours per day, 
five days a week. 

(e) The director of nursing shall cause the 
following to be accomplished: 

(1) establishment and implementation of 
nursing policies and procedures which 
shall include, but shall not be limited to 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1813 



PROPOSED RULES 



£A) 



the following: 
daily charting 



of any unusual 



occurrences or acute episodes related 
to patient care, and progress notes 
written monthly reporting each 
patient's performance in accordance 
with identified goals and objectives 
and each patient's progress toward 
rehabilitative nursing goals; 

(B) assurance of the delivery' of nursing 
services in accordance with 
physicians' orders, nursing care plans 
and the facility's policies and 
procedures; 

(C) notification of emergency physicians 
or on-call physicians; 

(D) infection control to prevent cross- 
infection among patients and staff; 

(E) reporting of deaths; 

(F) emergency reporting of fire, patient 
and staff accidents or incidents, or 
other emergency situations; 

(G) use of protective devices or restraints 
to ensure that each patient or resident 
is restrained in accordance with 
physician orders and the facility's 
policies, and that the restrained 
patient or resident is appropriately 
evaluated and released at a minimum 
of every two hours; 

(H) special skin care and decubiti care; 

(I) bowel and bladder training; 

(J) maintenance of proper body alignment 
and restorative nursing care; 

(K) supervising and assisting patients with 
feeding; 

(L) intake and output observation and 
reportin g for those patients whose 
condition warrants monitoring of their 
fluid balance. This will include those 
patients on intravenous fluids or tube 
feedings, and patients with kidney 
failure and temperatures elevated to 
102 degrees Fahrenheit or above; 

(M) catheter care; and 

(N) procedures used in caring for patients 
in the facility; 

(2) develop written job descriptions for 
nursing personnel; 

(3) periodic assessment of the nursing 
department and identification of 
personnel requirements as they relate to 
patient care needs and reporting same 
to the administrator; 

(4) orientation plan and continuing 



inservice education program for nursing 



employees and documentation of staf 
attendance and subject matter coverec 



15} 



during inservice education programs: 
provide appropriate reference material? 
for the nursing department, wh 
includes a Physician's Desk Reference 
or comparable drug reference, policy 
and procedure manual, and medi 
dictionary for each nursing station; anc 
establish of operational procedures to 
ensure that appropriate supplies and 
equipment are available to nursing staff 
as determined by individual patient care 
needs. 



Statutory Authority G.S. 131E-79. 



£6} 



.5310 NURSE STAFFING 
REQUIREMENTS 

(a) A hospital nursing facility or unit shall 



provide licensed nursing personnel sufficient to 
accomplished the following: 

(1) patient needs assessment; 
patient care planning; and 



121 
121 



supervisory functions in accordance 



with the level of patient or resident care 



advertised or offered by the facility. 
The facility also shall provide additional nursing 



personnel sufficient to ensure that the activities of 
daily living, personal grooming, restorative 



nursing actions and other health care needs 



identified in each patient's or resident's plan of 

care are met. 

(b) A multi-storied facility shall provide at least 



one direct care staff member on duty on each 
patient care floor at all times, 
(c) Daily direct patient care nursing staff. 



licensed and unlicensed, shall equal or exceed 2.1 
nursing hours per patient, (nursing hours per 
patient day or NHPPD or NH/PD.) 

(d) At least one licensed nurse shall be on duty 
for direct patient care at all times. 

(e) A registered nurse shall be on duty for at 
least eight consecutive hours a day, seven days a 
week. The Director of Nursing may be counted as 



meeting the requirements for both the director of 
nursing and patient and resident care staffing for 
facilities of a total census of 60 beds or less. 

(f) Nursing support personnel, including ward 
clerks, secretaries, nurse educators and persons 
primarily in administrative management positions 
and not actively involved in direct patient care 
shall not be counted toward compliance with 
minimum daily requirements for direct care 



1814 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



staffing. 

(g ) A facility shall not employ or contract, as a 
nurse aide, any individual not listed on the North 
Carolina Nurse Aide Registry, unless the 
individual is enrolled full-time in a nurse aide 
training and competency evaluation program 
approved by the Department; or the individual can 
prove that he or she has recently successfully 
completed a training and competency evaluation 
program a pproved by the Department and has not 
yet been included in the registry. Facilities must 
follow up to ensure that such individuals actually 
become registered. 

(h) The facility shall maintain an accurate record 
of qualifications and in-service training for each 
nurse aide employed by the facility. The facility 
shall provide, to the Department upon request, 
verification of employment of any nurse aide 
employed by. the facility in the previous 12 
months. 

Statutory Authority G.S. 131E-79. 

.5311 DOMICILIARY HOME 

PERSONNEL REQUIREMENTS 

(a) The administrator shall designate a person to 
be in charge of the domiciliary home residents at 
all times. 

(b) If domiciliary home beds are located in a 
separate building or a separate level of the same 
building, there shall be a person on duty in the 
domiciliary home areas at all times. 

(c) A facility shall provide sufficient staff to 
ensure that activities of daily living, personal 
grooming, and assistance with eating are provided 
to each resident. Medication administration as 
indicated by each resident's condition or 
physician's orders shall be carried out as identified 
in each resident's plan of care. 

(d) Domiciliary home facilities (Home for the 
Aged beds) licensed as a part of a combination 
facility shall comply with the staffing requirements 
of 10 NCAC 42D .1407 as adopted by the Social 
Services Commission for freestanding domiciliary 
homes and any subsequent amendments thereto. 

Statutory Authority G.S. 131E-79. 

.5312 REHABILITATIVE NURSING 
AND DECUBITUS CARE 

Each patient or resident shall be given care 
coordinated by the registered nurse to prevent 
contractures, deformities, and decubiti, including 
but not limited to: 

(1) changing positions of bedfast and 



12) 



13} 



141 
151 



chairfast patients or residents every two 
hours and administering simple 
preventive care. Documentation of such 
care and outcome must be included in 
routine summaries or progress notes; 
maintaining proper alignment and joint 
movement to prevent contractures and 
deformities. Documentation of such care 
must be included in routine summaries or 
progress notes; 

implementing an individualized bowel 
and bladder training program except for 
patients or residents whose records 
document that such training is not 
effective. A monthly summary for 
patients and quarterly summaries for 
domiciliary residents shall be written 
relative to each patient's or resident's 
performance in the bowel and bladder 
training program; 

providing adequate nutrition and 
hydration; and 

such other services as are necessary to 
meet the needs of the patient. 



Statutory Authority G.S. 131E-79. 

.5313 MEDICATION ADMINISTRATION 

(a) The administration of medication in nursing 
facility units shall comply with Rule .4511(a) of 
this Subchapter. 

(b) Verbal and telephone orders shall be 
countersigned by a physician within five days of 
issuance. 

Statutory Authority G.S. 131E-79. 

.5314 TRAINING 

(a) A hospital nursing facility or unit shall 
provide all employees a planned orientation and 
continuing education program emphasizing all 
patient or resident care policies and procedures, 
patients' rights, and staff performance 
expectations. Attendance and subject matter 
covered shall be documented for each session and 
available for licensure inspections. 

(b) The administrator shall ensure that each new 
employee is oriented to the facility's philosophy 
and goals within the first week of employment. 

(c) Each employee shall have specific on-the-job 
training as necessary for the employee to properly 
perform his individual job assignment. 

(d) Unless otherwise prohibited, a nurse aide 
trainee may be employed to perform the duties of 
a nurse aide for a period of time not to exceed 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1815 



PROPOSED RULES 



four months. During this period of time the nurse 
aide trainee shall be permitted to perform only 
those tasks for which minimum acceptable 
competence has been demonstrated and 
documented on a skills check-off record. Job 
applicants for nurse aide positions who were 
formerly qualified nurse aides but have not been 
gainfully employed as such for a period of 24 
consecutive months or more shall be employed 
only as nurse aide trainees and must re-quali fy as 
nurse aides within four months of employment by 
successfully passing an approved competency 
evaluation. An accurate record of nurse aide 
qualifications shall be maintained for each nurse 
aide employed by the facility and shall be retained 
in the general personnel files of the facility. 

(e) The curriculum content required for nurse 
aide level I education programs shall be subject to 
approval by the Division and shall include, as a 
minimum, basic nursing skills, personal care 
skills, cognitive, behavioral and social care, basic 
restorative services, and patients' rights. The 
minimum number of course hours shall be 75^ of 
which at least 20 hours shall be in the classroom 
and at least 40 hours shall be supervised practical 
experience. The initial orientation to the facility 
shall not be counted in the 75 hour training 
program. Competency evaluation shall be 
conducted in each of the following areas: 

(1) observation and documentation; 

(2) basic nursing skills; 

(3) personal care skills; 

(4) mental health and social service needs; 

(5) basic restorative services; and 

(6) Residents' Rights. 

(f) Successful course completion and skill 
competency shall be determined by competency 
evaluation approved by the Division. Nurse aides 
who have formerly been fully qualified under 
nurse aide training requirements may re-establish 
their qualifications by successfully passing a 
competency evaluation test. 

Statutory Authority G.S. 131E-79. 

.5315 DENTAL CARE 

(a) A dental examination shall be performed at 
the time of admission by a dentist or registered 
nurse. The results of the exam shall be placed in 
the patient's or resident's medical or health care 
record and shall include: 

(1) type of diet which the patient or 
resident can best manage (such as 
normal, soft or pureed); 
the presence of infection of gums. 



12) 



of 



teeth, or jaws; 

(3) brief descriptions of any removable 
dental appliances and a statement 
their condition; and 

(4) indications for dental treatment at the 
time of admission. 

fb) Names of dentists who have agreed to render 
emergency dental care shall be maintained at each 
nursing station in the nursing facility or unit and at 



the supervisor's station in a domiciliary home. 
(c) Staff of the facility shall ensure that: 



ill 

(21 



(3) 



necessary daily dental care is provided: 
each patient or resident possesses 



appropnate 
encouraged 



toothbrushes 
and, when 



and 
necessary, 



assisted in their use; and 
each patient or resident having a 
removable denture is furnished a 
receptacle in which to immerse the 
denture in water overnight. 



Statutory Authority G.S. 131E-79. 

.5316 AVAILABILITY OF 

PHARMACEUTICAL SERVICES 

(a) A hospital nursing facility or unit shall 
provide pharmaceutical services under the 
supervision of a pharmacist. 

fb) A hospital nursing facility or unit shall be 
responsible for obtaining drugs, therapeutic 
nutrients and related products prescribed or 
ordered by a physician for patients or residents in 
the facility. 

(c) Services shall include documented on-site 



pharmaceutical assessments accomplished at least 
every 31 calendar days for all patients and 
residents. 

(d) Hospital nursing facility or unit management 
shall ensure that action is taken in response to the 
recommendations made by the pharmacist. 

Statutory Authority G.S. 131E-79. 

.5317 DINING FACILnTES 

Patients, including wheelchair patients, shall be 
encouraged to eat at the tables in the dining area 
and shall be assisted when necessary by other than 
dietetic staff. Tables shall be of adequate height to 
accommodate wheelchair patients. An overbed 



table shall be provided for patients who eat in bed. 
Statutory Authority G.S. 131E-79. 

.5318 ACTTVnTES AND RECREATION 

(a) The administrator shall designate an 



1816 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



activities and recreation director to be in charge of 
activities and recreation for all patients and 
residents. The activities and recreation director 
shall have training and experience in directing 
recreational and group activities. The activities 
and recreation director shall be under the 
supervision of the administrator and shall be 
qualified to meet the needs of the patients and 
residents. Any director hired on or after the 
effective amended date of this Rule shall be a 
qualified professional who: 

(1) Is a therapeutic recreation specialist or 
therapeutic recreation assistant certified 
by. the North Carolina State Board of 
Therapeutic Recreation Certification 
pursuant to G.S. 90C-9 or is eligible 
for certification as a therapeutic 
recreation specialist by a recognized 
accrediting body; 

(2) Has had two years of experience in a 
social or recreation program within the 
last five years, one of which was full- 
time in a resident activities program in 
a health care setting; 

(3) Is a qualified occupational therapist or 
occupational therapy assistant licensed 
as such by the North Carolina Board of 
Occupational Therapy pursuant to G.S. 
90-270.70: 

(4) Is certified by the National Certification 
Council for Activity Professionals: or 

(5) Has completed an activities training 
course a pproved by the State. 

(b) The hospital nursing facility shall maintain 
and make available a listing of local resources for 
activities and recreation to be utilized in meeting 
the needs and interests of all patients and residents. 

(c) Restoration to self care and resumption of 
normal activity shall be one of the main goals of 
the recreation and activity program. The scope of 
the activity program shall include: 

(1) social activities involving individual and 
group participation which are designed 
to promote group relationship: 
indoor and outdoor recreational 
activities: 



12} 

I3J 

£4} 

15) 
£6} 

m 



opportunity to participate in activities 
outside the facility: 

opportunity to attend the church or 
religious program of his choice: 
creative and expressive activities: 
educational activities; and 
exercise. 

(d) The facility shall develop written policies 
and procedures which shall: 



(1) attempt to prevent the further mental or 
physical deterioration for those patients 
or residents who cannot realistically 
resume normal activities; 

(2) ensure o pportunities for patient 
involvement, both individual and group. 
in both planning and implementing the 
activity program; 

(3) provide patients or residents the 
opportunity for choice among a variety 
of activities; and 

(4) encourage participation by each patient 
or resident in social and recreational 
activities according to individual need 
and abilities and desires unless the 
patient's or resident's record contains 
documentation that he is unable to 
participate. 

£e} Each patient's or resident's activity plan 
shall be a part of his overall plan of care and shall 
contain documentation of periodic assessments of 
the individual's activity needs and interests. 

(f) A record of the activities offered and 
individuals participating in them shall be 
maintained in the facility. 

(g) A hospital nursing facility or unit shall 
display a monthly activities calendar which 
includes variety to appeal to different interest 
groups in the care and domiciliary home services. 

(Ti) A nursing facility or unit shall provide: 

(1) Space for recreational and diversional 
activities. In hospitals offering new 
nursing home services, space shall be 
provided separately from the main 
living and dining areas; however, these 
areas may also be used for social 
activities; 

(2) Designated indoor and outdoor activity 
areas for independent and group needs 
of patients and residents, and which 
are: 

(A) accessible to wheelchair and 
ambulatory patients; and 

(B) of sufficient size to accommodate 
necessary equipment and permit 
unobstructed movement of wheelchair 
and ambulatory patients or personnel 
responsible for instruction and 
supervision; and 

(3) Adequate space to store equipment and 
supplies without blocking exists or 
otherwise threatening the health and 
safety of patients and residents. 

£i] There shall be equipment and su pplies 
sufficient to carry out planned programs for both 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1817 



PROPOSED RULES 



individual and group activities. 
Statutory Authority G.S. 131E-79. 

.5319 SOCIAL SERVICES 

(a) The administrator shall designate an 
employee to be responsible for the provision of 
social services. This person shall be known as the 
social services director. Subsequent to the 
effective date of the rules contained in this 
Subchapter, any newly designated person must be 
a graduate of a four year college or university with 
one year's experience in the health care or long 
term care field or have an equivalent combination 
of education and experience. An equivalent 
combination of education and experience means 
the number of years of education leading to a 
baccalaureate or associate degree plus the number 
of years of long term nursing facility experience 
equal to five years; or eligible for certification as 
a social worker pursuant to G.S. 90B-7. The 
social services director shall have authority to 
carry out provisions contained in Paragraph (b) of 
this Rule. 

(b) Each patient's or resident's plan of care shall 
contain a written plan for meeting his individual 
social needs which shall involve active 



participation, 
following: 

(1) needed 



The plan shall address the 

assistance in meeting the 
patient's or resident's physical, social 
and emotional needs through 
consultation with the patient or resident, 
legal guardian, relative, physician or 
others; 

(2) assisting the patient or resident in 
adjusting to his environment; 

(3) referral to other supporting resources 
for protective services, for financial 
services and for assistance at the time 
of discharge or transfer into a new 
environment; and 

(4) the utilization of caseworkers employed 
by the county department of social 
services in the case of recipients of 
public assistance and for the utilization 
of appropriate persons with experience 
and training in the general area of 
social work in the case of those not on 
public assistance. 

(c) Discharge planning shall be in keeping with 
each patient's and resident's discharge needs. 
These are as follows: 

(1) The administrator shall ensure that a 
medical order for discharge, including 



any special instructions for meetin 



121 



rehabilitation potential, is obtained fo 
all patients or residents except when 
patient or resident leaves against 
physician's order or advice: and 
The social services director sha 
coordinate discharge instructions an< 
ensure that patients, residents and thei 
families have received the instructions. 



Statutory Authority G.S. 131E-79. 

.5320 RESTRAINTS 

(a) Patients and residents shall be restrained onl 



by physician order. 

(b) The nurse in charge shall be responsible fo 
making the decision relative to necessity for, typ 
and duration of restraint in emergency situation 



requirin g restraints while contacting the physician 
The nurse also shall be responsible fo 
documenting same in the patient's or resident' 
record. 

(c) The type of restraint used and the time o 
application and removal shall be recorded by \ 
nurse in the patient's or resident's record- 
ed) Chemical restraint shall be justified by. ; 
physician in the patient's medical record. Ord er: 



shall be time specific and address the outcome 
desired. 

Statutory Authority G.S. 131E-79. 

.5321 NURSING HOME PATIENT 
OR RESIDENT RIGHTS 

(a) Written policies and procedures shall be 
developed and enforced to implement requirement; 



in G.S. 131E-1 15 et seq. (Nursing Home Patients 
Bill of Rights) concerning the rights of patient; 
and residents. The administrator shall make these 



policies and procedures known to the staff, patient; 
and residents, and families of patients anc 
residents and shall ensure their availability to the 
public by placing them in a conspicuous place. 

(b) Any violation of patient rights contained m 
G.S. 131E-1 17 shall be determined by. 
representatives of the Division by investigation oi 
survey. 

(c) If a facility is found to be in violation of any 
of the rights contained in G.S. 131E-117, th 
Division shall impose penalties for each violation 
as provided by G.S. 131E-129. 

(d) When the Department has been notified that 
corrective action has been taken for each violation 



verification of same shall be made by a 
representative of the Division. 



1818 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



(e) The Department shall calculate a total of all 
fines levied against a facility based on the number 
of violations and the number of days and patients 
or residents involved in each violation. 

(f) The Department shall mail a statement to the 
facility showing a total fine for each violation and 
a total of fines due to be paid for all violations. 
The facility shall pay the penalty within 60 days 
unless a hearing js requested under G.S. 150B. 

(g) When it is found that a violation of G.S. 
131E-117 has occurred but corrective action was 
taken prior to the date of discovery, fines shall be 
calculated and assessed in accordance with 
Paragraphs (e) and (f) of this Rule. 

Statutory Authority G.S. 131E-79. 

.5322 BRAIN INJURY EXTENDED 
CARE PHYSICIAN SERVICES 

(a) For nursing facility patients located in 
designated brain injury long-term care units, there 
shall be an attending physician who is responsible 
for the patient's specialized care program. The 
intensity of the program requires that there shall be 
direct patient contact by a physician at least once 
per week and more often as the patient's condition 
warrants. Each patient's interdisciplinary, long 
term care program shall be developed and 
implemented under the supervision of a physiatrist 
{a physician trained in Physical Medicine and 
Rehabilitation) or a physician of equivalent 
training and experience appointed by the governing 
body. 

(b) If a physiatrist or physician of equivalent 
training or experience is not available on a weekly 
basis to the facility, the facility shall provide for 
weekly medical management of the patient, by 
another physician. In addition, oversight for the 
patient's interdisciplinary, long term care program 
shall be provided by a qualified consultant 
physician who visits patients monthly, makes 
recommendations for and a pproves the 
interdisciplinary care plan, and provides 
consultation as requested to the physician who is 
managing the patient on a weekly basis. 

(c) The attending physician shall actively 
participate in individual case conferences or care 
planning sessions and shall review and sign 
discharge summaries and records within 15 days of 
patient discharge. When patients are to be 
discharged to either another health care facility or 
a residential setting the attending physician shall 
ensure that the patient has been provided with a 
discharge plan which incorporates optimum 
utilization of community resources and post 



discharge continuity of care and services. 

Statutory Authority G.S. 131E-79. 

.5323 BRAIN INJURY EXTENDED 

CARE PROGRAM REQUIREMENTS 

(a) Brain injury long term care is an 
interdisciplinary, intensive maintenance program 
for patients who have incurred brain damage 
caused by external physical trauma and who have 
completed a primary course of rehabilitative 
treatment and have reach a point of no gain or 
progress for more than three consecutive months. 
Services are provided through a medically 
supervised interdisciplinary process as provided in 
Rule .5322 of this Section and are directed toward 
maintaining the individual at the optimal level of 
physical, cognitive and behavioral functioning. 
Following are the minimum requirements for 
specific services are necessary to maintaining the 
individual at optimum level: 

(1) Overall supervisory responsibility for 
brain injury long term care services 
shall be assigned to a registered nurse 
with one year experience in caring for 
brain injured patients; 

(2) Physical Therapy shall be provided by 
a physical therapist with a current 
North Carolina License. Occupational 
therapy shall be provided by an 
occupational therapist with a current 
North Carolina License. The services 
of a physical therapist and occupational 
therapist shall be combined to provide 
one full-time equivalent for each 20 
patients. The services of a physical 
therapy aide and an occupational 
therapy aide with appropriate 
supervision shall be combined to 
provide one full-time equivalent for 
each 20 patients. A proportionate 
number of hours shall be provided for 
a census less than 20 patients; 

(3) Clinical nutrition services shall be 
provided by a qualified dietitian. The 
number of hours of clinical nutrition 
services on either a fuH time or part- 
time employment or contract basis shall 
meet the needs of the patients. Each 
patient's nutrition needs shall be 
reviewed at least monthly. Clinical 
nutrition services shall meet the 
requirements of Section .4700 of this 
Subchapter and shall include but not be 
limited to: 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1819 



PROPOSED RULES 



(A) 



(B) 



££1 



£4) 



£51 



assessing the appropriateness of the 
ordered diet for conformance with 
each patient's physiological and 
pharmacological condition; 
evaluating each patient's laboratory 
data in relation to nutritional status 
and hydration; and 

applying technical knowledge of 
feeding tubes, pumps and equipment 
to each patient' specialized needs. 
Clinical social work shall be provided 
by. a social worker meeting the 
requirements of Rule .5319 of this 
Section; 

Recreation therapy when required, shall 
be provided on either a full-time or 
part-time employment or contract basis 
by a clinician eligible for certification 
as a therapeutic recreation specialist by 
the State Board of Therapeutic 
Recreation Certification. Therapeutic 
recreation services shall meet the needs 
of the patients. In the event that a 
qualified specialist is not locally 
available, alternate treatment modalities 
shall be developed by the occupational 
therapist and reviewed by the attending 
physician. The program designed shall 
meet the needs of this specialized 
population and must be administered in 
accordance with Rule .5318 of this 
Section: 



£6) 



01 



Speech therapy, when required, shall be 

provided by a clinician with a current 

license in speech pathology issued by 

the State Board of Audiology and 

Speech pathology; and 

Respiratory therapy, when required, 

shall be provided and supervised by a 

respiratory therapist currently registered 

by the National Board for Respiratory 

Care. 

(b) Each patient's program shall be governed by 

a interdisciplinary treatment plan incorporating and 

expanding upon the health plan required under 

Rules .5307 and .5308 of this Section. The plan 

is to be initiated on the first day of admission. 

Upon completion of baseline data development and 

an integrated interdisciplinary assessment, the 

initial treatment plan is to be expanded and 

finalized within 14 days of admission. The 

treatment plan shall be reviewed at least monthly 

through an interdisciplinary process and revised as 

appropriate. In executing the treatment plan the 

interdisciplinary team shall be the major decision- 



making body and shall determine the goals 
process and time frames for accomplishment o 
each patient's program. Disciplines to bj 
represented on the team shall be medicine, nursin; 
clinical pharmacy and all other disciplines directl- 



involved in the patient's treatment or treatmen 
plan. 

(c) Each patient's overall program shall bs 
assigned to an individually designated case 
manager. The case manager acts as thj 
coordinator for assigned patients. Am 

professional staff member involved in the patient': 



care may be assigned this responsibility for one o 
more patients. Professional staff may divide thi 
responsibility for all patients on the unit in the bes 
manner to meet all patients' needs for 
coordinated interdisciplinary approach to care 
The case manager shall be responsible for: 

(1) coordinating the development 



ill 

£3) 
14] 
£51 

£61 



implementation and periodic review of 

the patient's treatment plant; 

preparing a monthly summary of the 

patient's progress; 

cultivating the patient's participation ir 

the program; 

general supervision of the patient 

during the course of treatment; 

evaluating appropriateness of the 

treatment plan in relation to the 



attainment of stated goals; and 
assuring that discharge decisions and 
arrangements for post discharge follow- 
up are properly made, 
(d) For each 20 patients or fraction thereof. 



dedicated treatment facilities and equipment shall 
be provided as follows: 

(1) a combined therapy space equal to or 
exceeding 600 square feet, adequately 



£21 
£31 



£41 



equipped and arranged to support each 

of the therapies; 

access to one full reclining wheelchair 

per patient; 

special physical therapy and 

occupational therapy equipment for use 

in fabricating positioning devices for 

beds and wheelchairs including splints, 

casts, cushions, wedges, and bolster; 

and 

there shall be roll-in bath facilities with 

a dressing area available to all patients 



which shall afford maximum privacy to 
the patient. 

Statutory Authority G.S. 131E-79. 



1820 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



.5324 SPECIALNURSINGREQUIREMENTS 
BRAIN INJURY LONG TERM CARE 

Direct care nursing personnel staffing ratios 
(NH/PD) established in Rule .5310 of this Section 
shall not be applied to nursing services for patients 
who require brain injury long term care, due to 
their more intensive maintenance and nursing 
needs. The minimum direct care nursing staff 



shall be 5.5 hrs. per patient day allocated as the 
facility chooses to appropriately meet the patient 
needs. It is also required, that regardless of how 
low the patient census, the direct care nursing staff 
shall not fall below a registered nurse and a nurse 
aide I at any time during a 24 hour period. 

Statutory Authority G.S. 131E-79. 

.5325 VENTILATOR DEPENDENCE 

Hospital nursing facilities or units having patients 
requiring the use of ventilators for more than eight 
hours a day must meet the following requirements: 

(1) respiratory therapy shall be provided and 
supervised by. a respiratory therapist 
currently registered by the National 
Board for Respiratory Care. The respira- 
tory therapist shall: 

(a) make, as a minimum, weekly on-site 
assessments of each patient receiving 
ventilator support with corresponding 
progress notes: 

(b) be on-call 24 hours daily: and 

(c) assist the pulmonologist and nursing 
staff in establishing ventilator policies 
and procedures, including emergency 
policies and procedures: and 

(2) direct nursing care staffing shall be in 
accordance with Rule .5324 of this Sec- 
tion- 



least monthly with corresponding prog- 
ress notes: 

(3) be available on an emergency basis: and 

(4) participate in individual patient case 
planning. 

Statutory Authority G.S. 131E-79. 

.5327 EMERGENCY ELECTRICAL 
SERVICE 

(a) A minimum of one dedicated emergency 
branch circuit per bed is required for ventilator 
dependent patients in addition to the normal system 
receptacle at each bed location required by the 
National Electrical Code. This emergency circuit 
shall be provided with a minimum of two duplex 
receptacles identified for emergency use. Addi- 
tional emergency branch circuits/receptacles shall 
be provided where the electrical life support needs 
of the patient exceed the minimum requirements 
stated above. Each emergency circuit serving 
ventilator dependent patients shall be fed from the 
automatically transferred critical branch of the 
essential electrical system. This paragraph shall 
apply to both new and existing facilities. 

(b) Heating equipment provided for ventilator 
dependent patient bedrooms shall be connected to 
the critical branch of the essential electrical system 
and arranged for delayed automatic or manual 
connection to the emergency power source if the 
heating equipment depends upon electricity for 
proper operation. This paragraph shall apply to 
both new and existing facilities. 

Statutory Authority G.S. 131E-79. 

SECTION .5400 SPECIALLY 
DESIGNATED UNITS 



Statutory Authority G.S. 131E-79. 

.5326 PHYSICIAN SERVICES FOR 
VENTILATOR DEPENDENT 
PATIENTS 

Hospitals with nursing facility beds with ventila- 
tor dependent care patients shall contract with a 
physician who is licensed to practice hi North 
Carolina and who has specialized training in 
pulmonary medicine. This physician shall be 
responsible for respiratory services and shall: 

(1) establish, with the respiratory therapist 
and nursing staff, appropriate ventilator 
policies and procedures, including emer- 
gency procedures: 

(2) assess each ventilator patient's status at 



.5401 ADMISSIONS TO THE HTV 
DESIGNATED UNIT 

If a facility declines admission to a patient known 
to have Human Immunodeficiency Virus disease 
the reasons for the denial shall be documented. 

Statutory Authority G.S. 131E-79. 

.5402 DISCHARGE OF PATTENTS FROM 
THE HTV DESIGNATED UNIT 

(a) A record shall be maintained of all 
discharges of patients indicating the reasons for 
discharge, the physician's order for or other 
authorization for discharge, and the condition of 
the patient at the time of discharge. 

(b) A patient known to have Human 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1821 



PROPOSED RULES 



Immunodeficiency Virus disease may not be 
discharged solely on the basis of the diagnosis of 
Human Immunodeficiency Virus disease except as 
authorized by the provisions of G.S, 131 E- 117 
(15) or other provisions of the N. C. General 
Statutes or rules promulgated thereunder or 
provisions of applicable federal laws and 
regulations. 

Statutory Authority G.S. 131E-79. 

.5403 fflV DESIGNATED UNIT 

POLICIES AND PROCEDURES 

(a) In units dedicated to the treatment of patients 
with Human Immunodeficiency Virus disease, 
policies and procedures specific to the specialized 
needs of the patients served shall be developed. 
At a minimum they shall include staff training and 



education, and the availability of consultation by a 
physician with specialized education or knowledge 
in the management of Human Immunodeficiency 
Virus disease. 

(b) Policies and procedures for infection control 
shall be in conformance with 29 CFR 1910 
Occupational Safety and Health Standards which is 
incorporated by reference including subsequent 
amendments. Emphasis shall be placed on 
compliance with 29 CFR 1910-1030 (Bloodbourne 
Pathogens). Copies of Title 29 Part 1910 may be 
purchased from the Superintendent of Documents, 
W.S. Government Printing Office, Washington, 
D.S. 20402 for thirty eight dollars ($38.00) and 
may be purchased with a credit card by a direct 
telephone call to the G.P.O. at (202) 783-3238. 
Infection control shall also be in compliance with 
the Center of Disease Control Guidelines as 
published by the U.S. Department of Health and 
Human Services, Public Health Service which is 
incorporated by reference including subsequent 
amendments. Copies may be purchased from the 
National Technical Information Service. U.S. 
Department of Commerce, 5285 Port Royal Road, 
Springfield, Virginia, 22161 for fifteen dollars and 
ninety-five cents ($15.95). 

Statutory Authority G.S. 131E-79. 

.5404 PHYSICIAN SERVICES IN A HTV 
DESIGNATED UNIT 

In facilities with Human Immunodeficiency Virus 
designated unit, the facility shall insure that 
attending physicians have documented, pre- 
arranged access, either in person or by telephone, 
to a physician with specialized education or 
knowledge in the management of Human 



immunodeficiency Virus disease. 

Statutory Authority G.S. 131E-79. 

.5405 SPECIAL NURSING REQWREMENTS 
FOR A fflV DESIGNATED UNIT 

(a) Facilities with a Human Immunodeficiency 
Virus designated unit shall have a registered nurse 
with specialized education or knowledge in the 
care of Human Immunodeficiency Virus disease. 

(b) Nursing personnel assigned to the Human 
Immunodeficiency Virus unit shall be regularly 
assigned to the unit. Rotations are acceptable to 
alleviate staff burnout or staffing emergencies. 

Statutory Authority G. S. 131E-79. 

.5406 SPECIALIZED STAFF EDUCATION 
FOR THE HTV DESIGNATED UNIT 

For facilities with a Human Immunodeficiency 

Virus designated unit an organized, documented 

program of education specific to the care of 

patients infected with the HIV shall be provided 

and include at a minimum: 

(1) Human Immunodeficiency Virus and 

Acquired Immune Deficiency Syndrome 

disease processes; 

transmission modes. causes, and 



121 



ID 



14} 



15} 



£6} 



prevention of Human Immunodeficiency 

Virus; 

treatment of Human Immunodeficiency 

Virus and Acquired Immune Deficiency 

Syndrome; 

psycho-socio-economic needs of the 

Human Immunodeficiency Virus and 

Acquired Immune Deficiency Syndrome 

patients; 

in addition to the general hospital 

orientation to Occupational Safety and 

Health Administration guidelines for 

universal precautions, orientation to 

infection control specific to Human 

Immunodeficiency Virus disease must be 

provided upon employment or permanent 

assignment to the unit; Copies of Title 29 

Part 1910 may be purchased from the 

Superintendent of Documents, U.S. 

Government Printing Office, Washington, 

DC. 20402 for thirty eight dollars 

($38.00) and may be purchased with a 

credit card by a direct telephone call to 

the G.P.O. at (202) 783-3238; 

policies and procedures specific to the 

Human Immunodeficiency Virus 

designated unit; and 



1822 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



(7) annual continuing education in infection 
control . 

Statutory Authority G.S. 131E-79. 

5407 USE OF INVESTIGATIONAL DRUGS 
ON TIIE fflV DESIGNATED UNIT 

(a) The supervision and monitoring for the 
idministration of investigational drugs is the 



esponsibility of the pharmacist and a registered 



uirse, acting pursuant to the orders of a physician. 



Responsibilities shall include, but not be limited 



0^ the following: 

(1) to assure the provision of written 
guidelines for any investigational drug 
or study are provided; and 

(2) training and determination of staff's 
abilities regarding administration of 
drugs, policies and procedures and 
regulations. 

(b) The pharmacist or physician dispensing the 
investigational drug is to provide the facility with 



information regarding at least the following: 

(1) a copy of the investigational therapy 
protocol, including drug information; 

(2) a copy of the patient's informed consent 
to participate in study; 

(3) drug storage; 

(4) handling of drug; 

(5) any specific drug preparation and 
administration instruction; and 

(6) specific details for drug accountability, 
resupply and return of unused drugs. 

(c) Labeling of investigational drugs shall be m 
accordance with written guidelines of protocol and 



State and federal requirements regarding such 
drugs. Prescription labels for investigational drugs 
are to be distinguishable from other labels by an 
appropriate legend, "Investigational Drug" or "For 



Investigational Use Only". 

Statutory Authority G.S. 131E-79. 

.5408 SOCIAL WORK SERVICES IN A 
HIV DESIGNATED UNIT 

The facility shall provide either by direct 
employment or by contract for social work 
services to include assistance to the patient in 
identification of supportive resources, financial 
services and assistance with discharge and transfer 
arrangements. The social worker shall provide or 
arrange for the provision of spiritual, pastoral and 
grief counseling for patients and staff where 
appropriate. Support services shall be provided to 
patient families and significant others. Where 



12} 



necessary, coordination with treatment services for 
substance abuse, legal services and other 
community resources shall be identified. 

Statutory Authority C.S. 131E-79. 

SECTION .5500 COMPREHENSIVE 
INPATIENT REHABILITATION 

.5501 DEFINITIONS 

The following definitions shall apply to inpatient 
rehabilitation facilities or units only: 
(1) "Case management" means the 
coordination of services, for a given 
patient, between disciplines so that the 
patient may reach optimal rehabilitation 
through the judicious use of resources. 
"Comprehensive, inpatient rehabilitation 
program " means a program for the 
treatment of persons with functional 
limitations or chronic disabling conditions 
who have the potential to achieve a 
significant improvement in activities of 
daily living. A comprehensive, 

rehabilitation program utilize a 
coordinated and integrated, 
interdisciplinary a pproach , directed by a 
physician, to assess patient needs and to 
provide treatment and evaluation of 
physical, psycho-social and cognitive 
deficits. 

"Inpatient rehabilitation facility or unit" 
means a free-standing facility or a unit 
(unit pertains to contiguous dedicated 
beds and spaces) within an existing 
licensed health service facility approved 
in accordance with G.S. 131 E, Article 9 
to establish inpatient, rehabilitation beds 
and to provide a comprehensive, inpatient 
rehabilitation program. 
"Medical consultations" means 
consultations which the rehabilitation 
physician or the attending physician 
determine are necessary to meet the acute 
medical needs of the patient and do not 
include routine medical needs. 
"Occupational therapist" means any 
individual licensed in the State of North 
Carolina as an occupational therapist in 
accordance with the provisions of G.S. 
90, Article 18D. 

"Occupational therapist assistant" means 
any individual licensed in the State of 
North Carolina as an occupational 
therapist assistant in accordance with the 



13} 



£4) 



15} 



£6} 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1823 



PROPOSED RULES 



provisions of G.S. 90, Article 18D. 

(7) "Psychologist" means a person licensed 
as a practicing psychologist in accordance 
with G.S. 90, Article 18A. 

(8) "Phvsiatrist" means a licensed physician 
who has completed a physical medicine 
and rehabilitation residency training 
program approved by the Accrediting 
Council of Graduate Medical Education 
or the American Osteopathic Association. 

(9) "Physical therapist" means any person 
licensed in the State of North Carolina as 
a physical therapist in accordance with 
the provisions of G.S. 90, Article 18B. 

(10) "Physical therapist assistant" means any 
person licensed in the State of North 
Carolina as a physical therapist assistant 
in accordance with the provisions of G. 
S. 90-270.24, Article 18B. 

(11) "Recreational therapist" means a person 
certified by the State of North Carolina 
Therapeutic Recreational Certification 
Board. 

(12) "Rehabilitation nurse" means a registered 
nurse licensed in North Carolina, with 
training, either academic or on-the-job, 
in physical rehabilitation nursing and at 
least one year experience in physical 
rehabilitation nursing. 

(13) "Rehabilitation aide" means an unlicensed 
assistant who works under the 
supervision of a registered nurse, 
licensed physical therapist or 
occupational therapist in accordance with 
the appropriate occupational licensure 
laws governing his or her supervisor and 
consistent with staffin g requirements as 
set forth in Rule .5508 of this Section. 
The rehabilitation aide shall be listed on 
the North Carolina Nurse Aide Registry 
and have received additional staff training 
as listed in Rule .5509 of this Section. 

(14) "Rehabilitation physician" means a 
phvsiatrist or a physician who ]s 
qualified, based on education, training 
and experience regardless of specialty, of 
providing medical care to rehabilitation 
patients. 

(15) "Social worker" means a person certified 
by the North Carolina Certification Board 
for Social Work in accordance with G.S. 
90B-3. 

(16) "Speech and language pathologist" means 
any person licensed in the State of North 
Carolina as a speech and language 



pathologist in accordance with the 
provisions of G.S. 90, Article 22. 

Statutory Authority G. S. 131E-79. 

.5502 PHYSICIAN REQUIREMENTS FOR 
INPATIENT REHABILITATION 
FACILITIES OR UNITS 

(a) In a rehabilitation facility or unit, a 
rehabilitation physician shall participate in the 
provision and management of rehabilitation 



services and in the provision of medical services. 

(b) In a rehabilitation facility or unit, a 
rehabilitation physician shall be responsible for a 
patient's interdisciplinary treatment plan. Each 
patient's interdisciplinary treatment plan shall be 
developed and implemented under the supervision 
of the physician. 

(c) The rehabilitation physician shall participate 
in the preliminary assessment within 48 hours of 
admission, prepare a plan of care and direct the 
necessary frequency of contact based on the 
medical and rehabilitation needs of the patient. 
The frequency shall be appropriate to justify the 
need for comprehensive inpatient rehabilitation 
care. 

(d) An inpatient rehabilitation facility or unit's 
contract or agreements with a rehabilitation 
physician shall require that the rehabilitation 



physician shall participate in individual case 
conferences or care planning sessions and shall 
review and sign discharge summaries and records. 
When patients are to be discharged to another 
health care facility, the discharging facility shall 
ensure that the patient has been provided with a 
discharge plan which incorporates post discharge 
continuity of care and services. When patients are 
to be discharged to a residential setting, the facility 
shall ensure that the patient has been provided with 
a discharge plan that incorporates the utilization of 
community resources when available and when 
included in the patient's plan of care. 

(e) The intensity of physician medical services 
and the frequency of regular contacts for medical 
care for the patient shall be determined by the 
patient's pathophysiologic needs. 

(f) Where the attending physician of a patient in 
an inpatient rehabilitation facility or unit orders 
medical consultations for the patient, such 
consultations should be provided by qualified 
physicians within 48 hours of the physician's 
order. In order to achieve this result, the contracts 
or agreements between inpatient rehabilitation 
facilities or units and medical consultants shall 
require that such consultants render the requested 



1824 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



nedical consultation within 48 hours. 



(g) An inpatient rehabilitation facility or unit 
shall have a written procedure for setting the 
qualifications of the physicians, rendering physical 



•ehabilitation services in the facility or unit. 



Statutory Authority G.S. 131E-79. 

5503 ADMISSION CRITERIA FOR 
INPATIENT REHABILITATION 
FACILITIES OR UNITS 

(a) The facility shall have written criteria for 
admission to the inpatient rehabilitation facility or 



unit. A description of programs or services for 
creening the suitability of a given patient for 



placement shall be available to staff and referral 



purees. 



(b) For patients found unsuitable for admission 
o the inpatient rehabilitation facility or unit, there 
hall be documentation of the reasons. 



(c) Within 48 hours of admission, a preliminary 
assessment shall be completed by members of the 



nterdisciplinarv team to insure the appropriateness 



)f placement and to identify the immediate needs 
)f the patients. 

(d) Patients admitted to an inpatient 

ehabilitation facility or unit must be able to 



olerate a minimum of three hours of rehabilitation 



herapv, five days a week, including at least two of 



he following rehabilitation services: physical 
herapv. occupational therapy or speech therapy, 
(e") Patients admitted to an inpatient 

•ehabilitation facility or unit must be medically 



itable, have a prognosis indicating a progressively 



mproved medical condition and have the potential 



or increased independence. 

Statutory Authority G.S. 131E-79. 

5504 COMPREHENSIVE INPATIENT 
REHABILITATION EVALUATION 

(a) A comprehensive, inpatient rehabilitation 
evaluation is required for each patient admitted to 



in inpatient rehabilitation facility or unit. At a 
minimum this evaluation shall include the reason 



br referral, a summary of the patient's clinical 
condition, functional strengths and limitations, and 



ndications for specific services. This evaluation 



hall be completed within three days of admission. 

(b) Each patient shall be evaluated by the 

nterdisciplinarv team to determine the need for 



iny of the following services: medical, dietary, 
occupational therapy, physical therapy, prosthetics 



md orthotics, psychological assessment and 
herapv. therapeutic recreation, rehabilitation 



medicine, rehabilitation nursing, therapeutic 
counseling or social work, vocational rehabilitation 
evaluation and speech-language pathology. 

Statutory Authority G.S. 131E-79. 

.5505 COMPREHENSIVE INPATIENT 
REHABILITATION INTER - 
DISCIPLINARY TREAT/PLAN 

(a) The interdisciplinary treatment team shall 
develop an individual treatment plan for each 
patient within seven days after admission. The 
plan shall include evaluation findings and 
information about the following: 

(1) prior level of function: 

(2) current functional limitations; 

(3) specific service needs; 

(4) treatment, su pports and adaptations to 
be provided; 

(5) specified treatment goals; 

(6) disciplines responsible for 
implementation of separate parts of the 
plan; and 

(7) anticipated time frames for the 
accomplishment of specified long-term 
and short-term goals. 

(b) The treatment plan shall be reviewed by the 
interdisciplinary team at least every other week. 
All members of the interdisciplinary team, or a 
representative of the discipline, shall attend each 
meeting. Documentation of each review shall 
include progress toward defined goals and 
identification of any changes in the treatment plan. 

(c) The treatment plan shall include provisions 
for all of the services identified as needed for the 
patient in the comprehensive, inpatient 
rehabilitation evaluation completed in accordance 
with Rule .2023 of this Subchapter. 

(d) Each patient shall have a designated case 
manager who is responsible for the coordination of 
the patient's individualized treatment plan. The 
case manager is responsible for promoting the 
program's responsiveness to the needs of the 
patient and shall participate in all team conferences 
concerning the patient's progress toward the 
accomplishment of specified goals. Any of the 
professional staff involved in the patient's care 
may be the designated case manager for one or 
more cases, or the director of nursing or social 
worker may accept the coordination responsibility 
for the patients. 

Statutory Authority G.S. 131E-79. 

.5506 DISCHARGE CRITERIA FOR 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1825 



PROPOSED RULES 



INPATIENT REHABILITATION 
FACILITIES OR UNITS 

(a) Discharge planning shall be an integral part 
of the patient's treatment plan and shall begin upon 
admission to the facility. After established goals 
have been reached, or a determination has been 
made that care in a less intensive setting would be 
appropriate, or that further progress is unlikely, 
the patient shall be discharged to an appropriate 
setting. Other reasons for discharge may in clude 
an inability or unwillingness of the patient or his 
family to cooperate with the planned therapeutic 
program or medical complications that preclude a 
further intensive rehabilitative effort. The facility 
shall involve the patient, family, staff members 
and referral sources in discharge planning. 

(b) The case manager shall facilitate the 
discharge or transfer process in coordination with 
the facility social workers. 

(c) If a patient is being referred to another 
facility for further care, appropriate documentation 
of the patient's current status shall be forwarded 
with the patient. A formal discharge summary 
shall be forwarded to the receiving facility within 
48 hours following discharge and shall include the 
reasons for referral , the diagnosis, functional 
limitations, services provided, the results of 
services, referral action recommendations and 
activities and procedures used by. the patient to 
maintain and improve functioning. 

Statutory Authority G.S. 131E-79. 

.5507 COMPREHENSIVE 

REHABILITATION PERSONNEL 
ADMINISTRATION 

(a) The facility shall have qualified staff 
members, consultants and contract personnel to 
provide services to the patients admitted to the 
inpatient rehabilitation facility or unit. 

(b) Personnel shall be employed or provided by 
contractual agreement in sufficient types and 
numbers to meet the needs of all patients admitted 
for comprehensive rehabilitation. 

(c) Written agreements shall be maintained by 
the facility when services are provided by contract 
on an ongoing basis. 

Statutory Authority G.S. 131E-79. 

.5508 COMPREHENSIVE INPATIENT 
REHABILITATION PROGRAM 
STAFFING REQUIREMENTS 

(a) The staff of the inpatient rehabilitation 
facility or unit shall include at a minimum: 



£0 



ill 



£3) 



14} 



15] 



(6) 



the inpatient rehabilitation facility or 
unit shall be supervised by a 
rehabilitation nurse. The facility shall 
identify the nursing skills necessary to 
meet the needs of the rehabilitation 
patients in the unit and assign staff 
qualified to meet those needs; 
the minimum nursing hours per patient 
in the rehabilitation unit shall be 5.5 
nursing hours per patient day. At no 
time shall direct care nursing staff be 
less than two full-time equivalents, one 
of which must be a registered nurse: 
the inpatient rehabilitation unit shall 
employ or provide by contractual 
agreement sufficient therapist, licensed 
in North Carolina, to provide a 
minimum of three hours of specific 
(physical, occupational or speech) or 
combined rehabilitation therapy services 



per patient day; 

physical therapy assistants and 

occupational therapy assistants shall be 

licensed or certified and shall be 

supervised on-site by licensed physical 

therapists or licensed occupational 

therapists; 

rehabilitation aides shall have 



documented training appropriate to the 
activities to be performed and the 
occupational licensure laws of his or 
her supervisor. The overall 

responsibility for the on-going 
supervision and evaluation of the 
rehabilitation aide remains with the 
registered nurse as identified in 
Subparagraph (a)(1) of this Rule- 
Supervision by the licensed physical 
therapist or by the occupational 
therapist is limited to that time when 



the therapist is on-site and directing the 
rehabilitation activities of the aide; and 
hours of service by the rehabilitation 



aide are counted toward the required 
nursing hours when the aide is working 
under the supervision of the registered 
nurse. Hours of service by the 
rehabilitation aide are counted toward 



therapy hours during that time the aide 
works under the immediate, on-site 



supervision of the physical therapist or 
occupational therapist. Hours of 
services shall not be duly counted for 
both services. Hours of service by 
rehabilitation aides in performing nurse- 



1826 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



aide duties in areas of the facility other 
than the rehabilitation unit shall not be 
counted toward the 5.5 hour minimum 
nursing requirements described for the 
rehabilitation unit. 
(b) Additional personnel shall be provided as 
required to meet the needs of the patient, as 



defined in the comprehensive, inpatient rehabilita- 



tion evaluation. 



Statutory Authority G. S. 131E-79. 

5509 STAFF TRAINING FOR INPATIENT 
REHABILITATION FACILITIES OR 
UNIT 

Prior to the provision of care, all rehabilitation 
personnel, excluding physicians, assigned to the 
rehabilitation unit shall be provided training or 
shall provide documentation of training, that 
includes at a minimum the following: 
(1) active and passive range of motion; 
assistance with ambulation; 
transfers ; 

maximizing functional independence; 
the psycho-social needs of the rehabilita- 
tion patient; 

the increased safety risks of rehabilitation 
training (including falls and the use of 
restraints); 

proper body mechanics; 
nutrition, including dysphagia and restor- 
ative eating: 

communication with the aphasic and 
hearing impaired patient; 
behavior modification; 



12) 
01 
(4} 

m 

16} 



m 
m 

m 



an 

(12) 



bowel and bladder training; and 
skin care. 



Statutory Authority G.S. 131E-79. 

.5510 EQUIPMENT REQUIREMENTS/ 
COMPREHENSIVE INPATIENT 
REHABILITATION PROGRAMS 

(a) The facility shall provide each discipline 
with the necessary equipment and treatment meth- 



ods to achieve the short and long-term goals 
specified in the comprehensive inpatient rehabilita- 



tion interdisciplinary treatment plans for patients 
admitted to these facilities or units. 



(b) Each patient's needs for a standard wheel- 
chair or a specially designed wheelchair or addi- 



tional devices to allow safe and independent 



mobility within the facility shall be met. 



(c) Special physical therapy and occupational 
therapy equipment for use in fabricating positing 



devices for beds and wheelchairs shall be provided 
including splints, casts, cushions, wedges and 
bolsters. 

(d) Physical therapy devices, including a mat, 
table, parallel bars, and sliding boards, and special 
adaptive bathroom equipment shall be provided. 

Statutory Authority G.S. 131E-79. 

.5511 PHYSICAL FACILITY 

REQUIREMENTS/INPATIENT 
REHABILITATION FACILITIES 
OR UNIT 

(a) The inpatient rehabilitation facility or unit 
shall be in a designated area and shall be used for 
the specific purpose of providing a comprehensive, 
inpatient rehabilitation program. 

(b) The floor area of a single bedroom shall be 
sufficient for the patient or the staff to easily 
transfer the patient from the bed to a wheelchair 
and to maneuver a 180 degree turn with a wheel- 
chair between beds. 

(c) The floor area of a multi-bed bedroom shall 
be sufficient for the patient or the staff to easily 
transfer the patient from the bed to a wheelchair 
and to maneuver a 180 degree turn with a wheel- 
chair between beds. 

(d) Each patient room shall meet the following 
requirements: 

(1) maximum room capacity of no more 
than four patients; 

(2) operable windows; 

(3) a nurse call system designed to meet the 
special needs of rehabilitation patients; 

(4) in single and two-bed rooms with pri- 
vate toilet room, the lavatory may be 
located in the toilet room: 

(5) a wardrobe or closet for each patient 
which is wheelchair accessible and 
arranged to allow the patient to access 
the contents; 

(6) a chest of drawers or built-in drawer 
storage with mirror above, which is 
wheelchair accessible; and 

(7) a bedside table for toilet articles and 
personal belongings. 

(e) Space for emergency equipment such as 
resuscitation carts shall be provided and shall be 
under direct control of the nursing staff, jn 
proximity to the nurse's station and out of traffic. 

(f) Patients' bathing facilities shall meet the 
following specifications: 

(1) there shall be at least one shower stall 
or one bathtub for each 15 beds, if not 
availalbe in individual rooms. Each tub 



9:21 



NORTH CAROLINA REGISTER 



February I, 1995 



1827 



PROPOSED RULES 



or shower shall be in an individual 
room or privacy enclosure which 
provides space for the private use of the 
bathing fixture, for drying and dressing 
and for a wheelchair and an assisting 
attendant. 

(2) showers in central bathing facilities 
shall be at least five foot square without 
curbs and designed to permit use by a 
wheelchair patient. 

(3) at least one five-foot-by-seven-foot 
shower shall be provided which can 
accommodate a stretcher and an 



i£) 



assisting attendant. 
Patients' toilet rooms and 



lavatories shall 



meet the following specifications: 



ID 



the size of 
wheelchair, 



toilets shall 



a staff 
wheel-to-water 



permit a 

person and 

closet 



appropriate 
transfers. 

(2) Lavatories serving patients shall: 

(A) allow wheelchairs to extend under the 
lavatory; and 

(B) have water supply spout mounted so 
that its discharge point is a minimum 
of five inches above the rim of the 
fixture; and 

(3) Lavatories used by patients and by staff 
shall be equipped with blade-operated 
supply valves. 

(h) The space provided for physical therapy, 
occupational therapy and speech therapy by all 
inpatient rehabilitation facilities or units may be 
share d but shall, at a minimum, include: 



ill 
£21 

ill 
£41 

15) 
161 

m 

181 



office space for staff; 
office space for 



speech therapy 



evaluation and treatment; 

waiting space; 

training bathroom which includes toilet, 

lavatory and bathtub; 

gymnasium or exercise area; 

work area such as tables or counters 

suitable for wheelchair access; 



121 
(10) 



treatment areas with available privacy 

curtains or screens; 

an activities of daily living training 

kitchen with sink, cooking top (secured 

when not supervised by staff), 

refrigerator and counter surface for 

meal preparation; 

storage for clean linens, supplies and 

equipment; 

janitor's closet accessible to the therapy 

area with floor receptor or service sink 

and storage space for housekeeping 



supplies and equipment, one closet or 

space may serve more than one area of 

the inpatient rehabilitation facility or 

unit; and 

(11) hand washing facilities. 

£il For social work and psychological services 

the following shall be provided: 

(1) work space for technician; 

(2) space for evaluation and counseling for 
all family members; and 

£3J workspace for testing, evaluation and 
counseling. 

£jl If prosthetics and orthotics services are 
provided, the following space shall be made 
available as necessary: 

(1) work space for technician; and 

(2) space for evaluation and fittings (with 
provisions for privacy) . 

(k) If vocational therapy services are provided, 
the following space shall be made available as 
necessary: 

(1) office space for staff; 

workspace for vocational services 



£21 



activities such as prevocational and 

vocational evaluation; 
(3) training space; 
£41 storage for equipment; and 
(5) counseling and placement space. 
£11 Recreational therapy space requirements shall 



include the following: 

(1) activities space; 

£21 storage for equipment and supplies; 

(3) office space for staff; and 

£41 access to male and female toilets. 
(m) The following space shall be provided for 
patient's dining, recreation and day areas: 



(1) sufficient room 
and 



£21 if 



movement 

seating; 

if food service 

adequate width 

maneuvers, queue 



for wheelchair 
wheelchair dining 



is cafeteria type, 
for wheelchair 
space within the 



dining area (and not in a corridor) and 
a serving counter low enough to view 
food; 
£3J total space for inpatients, a minimum of 
25 square feet per bed; 

(4) for outpatients participating in a day 
program or partial day program, 20 
square feet when dining is a part of the 
program and 10 square feet when din- 
ing is not a part of the program; and 

(5) storage for recreational e quipment and 
supplies, tables and chairs. 

(6) the patient dining, recreation and day 



1828 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



area spaces shall be provided with 
windows that have glazing of an area 
not less than eight percent of the floor 
area of the space. At least one half of 
the required window area must be 
operable. 
(n) A laundry shall be available and accessible 
for patients. 



Statutory Authority G.S. 131E-79. 

.5512 ADDITIONAL REQUIREMENTS 

FOR TRAUMATIC BRAIN INJURY 
PATDZNTS 

Inpatient rehabilitation facilities providing servic- 
es to persons with traumatic brain injuries shall 
meet the requirements in this rule in addition to 
those identified in this Section. 

(1) Direct-care nursing personnel staffing 
ratios established in Rule .5508 of this 
Section shall not be applied to nursing 
services for traumatic brain injury pa- 
tients in the inpatient, rehabilitation 
facility or unit. The minimum nursing 
hours per traumatic brain injury patient 
in the unit shall be 6^5 nursing hours per 
patient day. At no time shall direct care 
nursing staff be less than two full-time 
equivalents, one of which shall be a 
registered nurse. 

(2) The inpatient rehabilitation facility or unit 
shall employ or provide by contractual 
agreements physical, occupational or 
speech therapists in order to provide a 
minimum of 4^5 hours of specific or 
combined rehabilitation therapy services 
per traumatic brain injury patient day. 

(3) The facility shall provide special facility 
or equipment needs for patients with 
traumatic brain injury, including a quiet 
room for therapy, specially designed 
wheelchairs and standing tables. 

(4) The medical director, appointed by the 
governing body, of an inpatient traumatic 
brain injury program shall have two 
years management in a brain injury pro- 
gram, one of which may be in a clinical 
fellowship program and board eligibility 
or certification in the medical specialty of 
the physician's training. 

(5) The facility shall provide the consulting 
services of a neuropsychologist. 

(61 The facility shall provide continuing 
education in the care and treatment of 
brain injury patients for all staff. 



(7) The size of the brain injury program shall 
be adequate to su pport a comprehensive, 
dedicated ongoing brain injury program. 

Statutory Authority G.S. 131E-79. 

.5513 ADDITIONAL REQUIREMENTS 
FOR SPINAL CORD INJURY 
PATIENTS 

Inpatient rehabilitation facilities providing servic- 

es to persons with spina! cord injuries shall meet 

the requirements in this rule in addition to those 

identified in this Section. 

(1) Direct-care nursing personnel staffing 

ratios established in Rule .5508 of this 

Section shall not be a pplied to nursing 

services for spinal cord injury patients in 

the inpatient, rehabilitation facility or 

unit. The minimum nursing hours per 

spinal cord injury patient in the unit shall 

be 6.0 nursing hours p er patient day. At 

no time shall direct care nursing staff be 

less than two full-time equivalents, one of 

which shall be a registered nurse. 

(21 The inpatient rehabilitation facility or unit 

shall employ or provide by contractual 

agreements physical, occupational or 

speech therapists in order to provide a 

minimum of 4_X) hours of specific or 

combined rehabilitation therapy services 

per spinal cord injury patient day. 

(3) The facility shall provide special facility 
or special equipment for the patient with 
spinal cord injury, including specially 
designed wheelchairs, tilt tables and 
standing tables. 

(4) The medical director, a ppointed by the 
governing body, of an inpatient spinal 
cord injury program shall have either two 
years experience in the medical care of 
persons with spinal cord injuries or six 
month's minimum in a spinal cord injury 
fellowship. 

(5) The facility shall provide continuing 
education in the care and treatment of 
spinal cord injury patients for all staff. 

(6) The facility shall provide specific staff 
training and education in the care and 
treatment of spinal cord injury. 

(7) The size of the spinal cord injury 
program shall be adequate to su pport a 
comprehensive, dedicated ongoing spinal 
cord injury program. 

Statutory Authority G.S. 131E-79. 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1829 



PROPOSED RULES 



.5514 DEEMED STATUS FOR INPATIENT 
REHABILITATION FACILITIES OR 
UNIT 

(a) If an inpatient rehabilitation facility or unit 
with a comprehensive inpatient rehabilitation 
program is surveyed and accredited by the Joint 
Commission for the Accreditation of Health Care 
Organizations (JCAHO) or the Commission on 
Accreditation of Rehabilitation Facilities (CARF) 
and has been approved by the Department in 
accordance with Article 9 Chapter 13 1 E of the 
North Carolina General Statutes, the Division 
deems the facility to be in compliance with Rules 
.2020 through .2030 and .2033 of this Subchapter. 

(b) Deemed status shall be provided only if the 
inpatient rehabilitation facility or unit provides 
copies of survey reports to the Division. The 
JCAHO report shall show that the facility or unit 
was surveyed for rehabilitation services. The 
CARF report shall show that the facility or unit 
was surveyed for comprehensive rehabilitation 
services. The facility or unit shall sign an 
agreement (Memorandum of Understanding) with 
the Division specifying these terms. 

(c) The inpatient rehabilitation facility or unit 
shall be subject to inspections or complaint 
investigations by representatives of the Division at 
any time. If the facility or unit is found not to be 
in compliance with the rules listed in Paragraph (a) 
of this Rule, the facility shall submit a plan of 
correction and be subject to a follow-up visit to 
ensure compliance. 

(d) If the inpatient rehabilitation facility or unit 
loses or does not renew its accreditation, the 
facility or unit shall notify the Division in writing 
within 30 days. 

Statutory Authority G.S. 131E-79. 

SECTION 5600 - .5900 - RESERVED 
FOR FUTURE CODIFICATION 

SECTION .6000 - PHYSICAL PLANT 

.6001 LOCATION 

(a) The site of any facility shall be accessible to 
service vehicles, fire protection and emergency 
apparatus. 

fb) The water supply system available to the site 
shall be tested to determine the mineral and salts 
content and their effect on the various water 
systems in the facility. When these tests indicate 
the facility will have problems in maintenance and 
upkeep, the facility shall provide a water treatment 
system. 



Statutory Authority G.S. 131E-79. 

.6002 ROADS AND PARKING 

(a) Paved roads shall be provided within the 
property lines to provide access to the main 
entrance, emergency entrance, and to service 



entrances, including loading and unloading docks 
for delivery trucks. 
fb) Facilities having an organized emergency 



services department shall have the emergency 



entrance well marked to facilitate entry from the 
public roads or streets serving the site. 

(c) Paved walkways shall be provided for 
necessary pedestrian traffic. 

(d) Off-street parking shall be made available 
for patients, staff, and visitors. 

Statutory Authority G. S. 131E-79. 

SECTION .6100 - GENERAL 
REQUIREMENTS 

.6101 GENERAL 

The design, construction, maintenance and 
operation of a facility shall be in accordance with 
those codes and standards listed in Rule .6102. 
LIST OF REFERENCED CODES AND 
STANDARDS of this Section, and codes, 
ordinances, and regulations enforced by city, 
county, or other state jurisdictions with the 
following requirements: 

(1) Notify the Division when all construction 
or renovation has been completed, 
inspected and approved by the architect 
and engineer having responsibility, and 
the facility is ready for a final inspection. 
Prior to using the completed project, the 
facility shall receive from the Division, 
written approval for use. The approval 
shall be based on an on-site inspection by 
the Division or by documentation as may 
be required by the Division; 

(2) In the absence of any requirements by 
other authorities having jurisdiction, 
develop a master fire and disaster plan 
with input from the local fire department 
and local emergency management agency 
to fit the needs of the facility. The plan 
shall require: 

(a) Training of facility employees in the 
fire plan implementation, in the use of 
fire-fighting equipment, and in 
evacuation of patients and staff from 
areas in danger during an emergency 
condition: 



1830 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



(b) Conducting of quarterly fire drills on 
each shift; 

(c) A written record of each drill shall be 
on file at the facility for at least three 
years; 

(d) The testing and evaluation of the 
emergency electrical system (s) once 
each year by simulating a utility 
power outage by opening of the main 
facility electrical breaker(s). 
Documentation of the testing and 
results shall be completed at the time 
of the test and retained by the facility 
for three years: and 

(e) Disaster planning to fit the specific 
needs of the facility's geographic 
location and disaster history, with at 
least one documented disaster drill 
conducted each year. 

Statutory Authority G.S. 131E-79. 

.6102 LIST OF REFERENCED 

CODES AND STANDARDS 

The following codes and standards are adopted 
by reference including subsequent amendments- 
Copies of these publications can be obtained from 
the various organizations at the addresses listed: 
£]Q The North Carolina State Building Code, 
current edition, all volumes including 
subsequent amendments. Copies of this 
code may be purchased from the N.C. 
Department of Insurance Engineering 
Division located at 410 North Boylan 
Avenue. Raleigh. NC 27603 at a cost of 
two hundred fifty dollars ($250.00). 
The National Fire Protection Association 



£2} 



codes, current edition, all volumes 
including subsequent amendments. 



on 



Copies of these codes and standards may 
be obtained from the National Fire 
Protection Association. 1 Batterymarch 
Park. PO Box 9101. Quincy, MA 
02269-9101 at a cost of sjx hundred 
twenty-five dollars ($625.00). 
"Rules Governing the Sanitation of 
Hospitals. Nursing and Rest Homes. 
Sanitariums. Sanitoriums. and 
Educational and Other Institutions" of the 
N.C. Department of Environment. Health 
and Natural Resources, current edition 
including subsequent amendments- 
Copies of these rules may be obtained 
from the N.C. Department of 
Environment. Health and Natural 



Resources, Division of Environmental 
Health. Environmental Health Services 
Section, 512 N. Salisbury Street, 



I4J 



15} 



Raleigh, NC 27604-1 148 at no cost. 
American Society of Heating, 
Refrigerating & Air Conditioning 
Engineers, (ASHRAE) HVAC Systems 
and Equipment, current edition including 
subsequent amendments. Copies of this 
document may be obtained from the 
American Society of Heating, 
Refrigerating & Air Conditioning 
Engineers at United Engineer Center, 
345 East 47th Street, New York, NY 
10017 at a cost of one hundred nineteen 
dollars ($119.00). 

Rules and Statutes Governing the 
Licensure of Ambulatory Surgical 
Facilities, current edition including 
subsequent amendments. Copies of this 
document may be obtained from the N.C. 
Department of Human Resources, 
Division of Facility Services, Licensure 
Section, 701 Barbour Drive, Raleigh, NC 
27603 at a cost of three dollars ($3.00). 
The Standards for Obstetric-Gynecologic 
Services, current edition including 
subsequent amendments. Copies of this 
standard may be obtained from The 



161 



American College of Obstetricians and 
Gynecologists, 600 Maryland Avenue, 
SW, Suite 700 East, Washington, DC 
20024-2588 at a cost of thirty five dollars 
($35.00). 

Statutory Authority G.S. 131E-79. 

.6103 APPLICATION OF PHYSICAL 
PLANT REQUIREMENTS 

The physical plant requirements for each facility 
shall be applied as follows: 

(1) New construction shall comply with the 
requirements of Section .6000 of this 
Subchapter; 

(2) Existing buildings shall meet licensure 
and code requirements in effect at the 
time of construction, alteration, or 
modification: 

(3) New additions, alterations, modifications, 
and repairs shall meet the technical 
requirements of Section .6000 of this 
Subchapter, however. where strict 
conformance with current requirements 
would be impractical, the authority 
having jurisdiction may approve 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1831 



PROPOSED RULES 



alternative measures where the facility 
can demonstrate to the Division's 
satisfaction that the alternative measures 
do not reduce the safety or operating 
effectiveness of the facility; 

(4) Rules contained in Section .6000 of this 
Subchapter are minimum requirements 
and not intended to prohibit buildings, 
systems or operational conditions that 
exceed minimum requirements; 

(5) Equivalency: Alternate methods, 
procedures, design criteria, and 
functional variations from the physical 
plant requirements. because of 
extraordinary circumstances. new 
programs, or unusual conditions, may be 
approved by the authority having 
jurisdiction when the facility can 
effectively demonstrate to the Division's 
satisfaction, that the intent of the physical 
plant requirements are met and that the 
variation does not reduce the safety or 
operational effectiveness of the facility; 
and 

(6) Where rules, codes, or standards have 
any conflict. the most stringent 
requirement shall apply. 

Statutory Authority G.S. 131E-79. 

.6104 ACCESS AND SAFETY 

Projects involving replacement, alterations of. 
and additions to existing facilities shall be planned 
and phased so that construction will minimize 
disruptions of essential facility operations. Facility 
access, exit ways, safety provisions, and building 
and life safety systems shall be maintained so that 
the health and safety of the occupants will not be 
jeopardized during construction. Additional safety 
and operating measures shall be planned and 
executed to compensate for hazards related to 
construction or renovation activities to maintain an 
equivalent degree of health, safety, and operational 
effectiveness to that required by rules, standards, 
and codes for a facility not under construction or 
renovation. 

Statutory Authority G.S. 131E-79. 

SECTION .6200 - CONSTRUCTION 
REQUIREMENTS 

.6201 MEDICAL, SURGICAL AND 
POSTPARTUM CARE UNIT 

The following requirements shall apply to 



licensed 

ia) 
ffil 



beds: 
Each 



patient room shall meet the 



id) 



® 



is) 



mi 



i2) 



(a) 

OH 

L±l 
id) 



following requirements: 
Maximum room capacity shall be four 
patients ; 

Minimum room areas exclusive of toilet 
rooms, closets, lockers, wardrobes- 



bathing room, or vestibules shall be 100 
square feet in single bed rooms and 80 
square feet per bed in multi-bed rooms: 



Provide a minimum of three feet of 

clear working space on three sides of 

each bed; 

A window which can be opened from 

the inside shall be provided. The 

window sill shall not be higher than 

three feet above the floor and shall be 

above grade; 

A nurses' calling station at each patient 



bed and toilet room shall be provided: 
At least one lavatory shall be provided 
in each patient room. In a single 



bedroom other than post-partum rooms. 



the lavatory may be omitted from the 
patient room when a lavatory is located 
in an adjoining toilet room which serves 
that room only; 

A toilet room containing a water closet 
and a lavatory shall be provided to 
serve no more than four beds or two 
patient rooms; 

A wardrobe, locker or closet shall be 
provided for each patient suitable for 
hanging garments as well as for storage 
of personal effects; and 
Provision shall be made for the visual 
privacy of each patient in multi-bed 
rooms. 
The following service areas shall be 
located no further than 120 feet travel 
distance from each patient bedroom door: 
Nurses' station; 

Hand washing facilities located at the 
nurses' station; 
Charting facilities; 

A clean workroom or a clean holding 
room for storage and distribution of 
clean supply materials. The clean 
workroom shall contain a work counter 
and hand washing and storage facilities. 



A clean holding room shall be similar 
to a clean workroom except it shall be 
a part of a clean supply system and the 
work counter and hand washing 
facilities may be omitted; 



1832 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



£3} 



Id) 



(e) A soiled workroom or a soiled holding 
room as a part of a system for the 
collection and disposal of soiled 
materials. The soiled workroom shall 
contain a clinical sink or other suitable 
flushing device, sink e quipped for hand 
washing, a work counter, a waste 
receptacle, and a linen receptacle. A 
soiled holding room shall be similar to 
the soiled workroom except that it shall 
be a part of the soiled disposal system . 
The waste receptacle clinical sink and 
work counter may be omitted; 

(f) A drug distribution station that meets 
the current minimum requirements of 
governing state and federal agencies 
regulating controlled substances 
including a lavatory; 

(g) A clean linen storage closet. This may 
be a designated area within the clean 
workroom. If a closed cart system is 
used, storage may be in a controlled 
alcove out of corridor traffic; 

(h) A nourishment station that contains a 
lavatory. equipment for serving 
nourishment between meals, 
refrigerator and storage facilities. Ice 
dispensing facilities for patient service 
and treatment shall be of a type that 
will not require use of scoops; 
Storage of equipment including 
emergency equipment shall be provided 
to insure corridors are kept clear; and 
Parking for stretchers and wheelchairs 
located out of corridor widths. 

shall 



The following service areas 
provided for each nursing unit: 

Nurses office; 

Closets or compartments 

safekeeping of coats and 

effects of staff; 

Conference room: 



be 



for the 
personal 



Room for examination and treatment of 
patients. This room may be omitted if 
all patient rooms are single-bed rooms. 
This room shall have a minimum floor 
area of 100 square feet, excluding space 
for vestibule less than eight feet wide, 
toilet, closets and work counters 
(whether fixed or movable). The 
minimum room dimension shall be 10 
feet. The 
lavatory, a 



® 



(£} 



room 
work 



shall contain a 
counter, storage 

facilities and a desk, counter or shelf 

space for writing: 



Lounge and toilet room for staff; 
Janitors' closet. This room shall 
contain a floor receptor or service sink 
and storage space for housekeeping 
supplies and equipment; and 
Individually enclosed bathtubs or 
individually enclosed showers at the 
rate of one for each 12 beds or fraction 
thereof which are not otherwise served 
by bathing facilities within the patient 
rooms. 

(4) Each facility shall make provisions for at 
least one room for patients needing close 
supervision including provisions to 
minimize the chance of a patients' hiding, 
escape, injury or suicide. 

(5) Isolation Rooms. Rooms for patients 
requiring isolation for infection control 
purposes shall be provided at the ratio of 
one isolation room for each 30 acute care 
licensed beds or major fraction thereof. 
These may be located within each nursing 
unit or placed together in a separate unit. 
Each isolation room shall be a single-bed 
room and shall conform to the 
requirements of Paragraph (a) of this 
Rule except as follows: 

(a) A private toilet room containing a water 
closet and a bath or shower for the 
exclusive use of the patient which can 
be entered directly from the patient bed 
area without passing through the 
vestibule or anteroom shall be 
provided; 

(b) A lavatory for the exclusive use of the 
patient shall be provided. It may be 
located in the patient room or in the 
private toilet room; 

(c) Entrance from the corridor shall be 
through a closed anteroom which 
contains facilities to assist staff 
personnel in maintaining aseptic 
conditions. The anteroom shall contain 
a lavatory equipp ed for hand washing, 
storage for clean and soiled materials, 
and gowning facilities; and 

(d) A view window in the door for nursing 
observation of the patient from the 
anteroom shall be provided. 

(6) Provision shall be made for delivery of 
medications to patients. All medications 
and related items shall be stored in 
compliance with current Federal and 
State laws and rules and made accessible 
only to authorized personnel . A 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1833 



PROPOSED RULES 



medication preparation area, alcove. 



room or other designated area shall be 
under the direct supervision of the 
nursing staff when not in use. It shall 
contain at least a work counter, lavatory, 
medication-only refrigerator and 
designated locked area for controlled 
substances; if mobile systems are used, 
storage in corridors is prohibited except 
when in use by the nursing staff. 

Statutory Authority G.S. 131E-79. 

.6202 SPECIAL CARE UNIT 

(a) Each patient room shall meet the following 
requirements: 

(1) Clearance between beds in multi-bed 
rooms shall be not less than 7 feet with 
provision for visual privacy of patients. 
Each patient bed space shall have a 
minimum of 130 square feet with a 
minimum dimension of J_l feet; 

(2) One single isolation bedroom shall be 
provided for each 12 special care beds 
or fraction thereof; 

(3) Glazing in all viewing panels in 
partitions and doors shall be safety 
glass, wire glass, or fire rated glass; 

(4) A lavatory shall be provided in each 
patient room. In multi-bed rooms, 
lavatories shall be provided within K) 
feet of each bed; 

(5) A nurse call system is required except 
in neonatal units: 

(6) Each single-bed cubicle or room shall 
have a window to the outdoors. In the 
case of ward-type patient bed areas of 
two or more patients where cubicle 
privacy curtains are used, at least one 
window shall be provided for every two 
beds. Windows shall be positioned to 
provide a maximum distance of _18 feet 
between the normal head position of 
each patient and a window. Window 
sills shall not exceed five feet above the 
floor; and 

(7) Toilet facilities provided for each 
special care unit shall be accessible 
from within the unit. Portable toilets 
may be used within the patient room. 
Storage and service of portable toilets 
shall be provided, if used. Fixed toilets 
shall have sufficient clearance to 
facilitate use by patients needing 
assistance. 



(b) The service elements and areas listed below 
shall be provided within each special care unit: 



ill 

121 
01 
(4) 
151 
161 



Oil 



(12) 

(13) 
(14) 




A nurses' station located to 

direct visual observation of each 

served; 

Hand washing facilities convenient to 

nurses' station; 

Designated charting space in addition to 

monitoring service space; 

A staff toilet room containing a water 

closet and a lavatory; 

Facilities for the safekeeping of coats 

and personal effects of staff; 

A clean workroom or a system for 

storage and distribution of clean 

supplies. The clean area shall contain 



a work counter, hand washing facilities 
and storage facilities; 
(7) A soiled workroom, or a soiled holding 



room as part of a system for the 
collection and disposal of soiled 



materials. The soiled workroom shall 
contain a clinical sink or other flushing 
device, a sink equipped for hand 
washing, and a work counter. A soiled 
holding room shall be similar to the 
soiled workroom except that the clinical 
sink and work counter may be omitted: 

(8) A drug distribution station that meets 
the current minimum requirements of 
governing state and federal agencies 
including lavatory; 

(9) A clean linen storage closet or alcove. 
This may be a designated area within 
the clean workroom. If a closed cart 
system is used, storage may be in a 
controlled alcove clear of corridor 
width: 

(10) A nourishment 



equipment for 
between meals. 



storage facilities- 



area with a sink, 
serving nourishment 
a refrigerator, and 
New or replacement 
ice dispensing equipment for patient 
service shall be of a self-dispensing 
type that will not require use of 
utensils; 

Storage area for emergency and other 
rolling equipment outside of corridor 
width; 

Secure facilities for storage of patients' 
personal effects; 
Bedpan washing devices; and 
A separate waiting room with seating 
accommodations for visitors, a toilet 
room, and a public telephone. The 



1834 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



waiting room may serve more than one 
special care unit. 

Statutory Authority G.S. 131E-79. 

.6203 NEONATAL LEVEL I NURSERY 
UNIT 

(a) Neonatal infant units shall be on the same 
floor as post-partum nursing units. No nursery 
shall open directly into another nursery. Each 
nursery shall contain the following: 

(1) Lavatory located within 10 feet travel 
distance of each bassinet; 

(2) Emergency calling system; 

(3) Glazed observation windows for 
viewing infants from public areas: and 

(4) Charting facilities. 

(b) A full term nursery shall contain not more 
than 24 bassinets. The minimum floor area per 
bassinet shall be 30 square feet clear and there 
shall be 3 feet clear in all directions around each 
bassinet- 
te) Each nursery shall be served by a connecting 

workroom . It shall contain gowning facilities at 
the entrance for staff and housekeeping personnel, 
lavatory, and storage area. One workroom may 
serve more than one nursery. 

(d) Space for examination and treatment shall 
contain a counter, storage, and a lavatory. It may 
serve more than one nursery room and may be 
located in a workroom . 

(el If commercially-prepared formula is not 
used, space and equipment to accommodate the 
handling, storage, and preparation of formula shall 
be provided. 

(f) A janitor's closet for the exclusive use of the 
housekeeping staff in maintaining the nursery suite 
shall be provided. It shall contain a floor receptor 
or service sink and storage space for housekeeping 
equipment and supplies. 

(g) Doors to nurseries shall be no less than three 
feet wide. If doors are provided directly from 
nurseries to public corridors or public spaces, they 
shall be equipped with "one-way" hardware for 
exit only to prevent unauthorized entry. 

(h) Smoke detection shall be provided in each 
nursery bed space. 

Statutory Authority G.S. 131E-79. 

.6204 NEONATAL LEVEL II AND 
HI NURSERY 

(a) Units shall be accessible to post-partum 
nursing and delivery units. 

(b) The nursery shall be located and arranged to 



preclude unrelated traffic through the nursery. 

(c) Each nursery shall contain the following: 

(1) Lavatory located within ten feet travel 
distance of each bassinet; 

(2) Emergency calling system; and 

(3) Charting facilities. 

(d) There shall be six feet between bassinets for 
neonatal care units and five feet between bassinets 
for intermediate care units. Neonatal care 
nurseries shall have 80 square feet per bassinet not 
including corridors and cabinets. Intermediate 
care nurseries shall have 50 square feet per 
bassinet not including cabinets and corridors. 
Corridors or aisles shall have at least eight feet of 
clear width for access to bassinets. 

(e) Each nursery shall be served by a connecting 
workroom. It shall contain gowning facilities at 
the entrance for staff and housekeeping personnel, 
lavatory, and storage. One workroom may serve 



more than one nursery. The workroom may be 
omitted if equivalent work area and facilities are 
provided within the nursery. Gowning and hand 
washing facilities shall be provided at the entrance 
to each nursery. 

(f) Space for examination and treatment shall be 
provided and shall contain a counter, storage, and 
lavatory. It may serve more than one nursery room 
and may be located in a workroom. 

(g) If commercially prepared formula ]s not 
used, space and equipment to accommodate the 
handling, storage, and preparation of formula shall 
be provided. 

(h) A janitor's closet for the exclusive use of the 
housekeeping staff in maintaining the nursery suite 
shall be provided. It shall contain a floor receptor 
or service sink and storage space for housekeeping 
equipment and su pplies. 

(ij Doors to nurseries shall be no less than three 
feet wide. If doors are provided directly from 
nurseries to public corridors or public spaces, they 
shall be equipp ed with "one-way" hardware for 
exit only to prevent unauthorized entry. 

(jj Smoke detection shall be provided in each 
nursery bed space. 

Statutory Authority G.S. 131E-79. 

.6205 PSYCHIATRIC UNIT 

When a facility elects to establish an identifiable 

psychiatric unit, the following requirements shall 

be met: 

(1) Patient rooms shall meet the requirements 

of Rule .6201 of this Section with the 

following exceptions: 

Patient room doors shall be designed 



(a) 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1835 



PROPOSED RULES 



with hardware that will permit the emergency communication system connected to the 



fb] 



l£l 



id) 



fe) 



if) 



III 



£11 

mi 



doors to swing into the corridors by the 

use of a special tool for emergency 

purposes; 

Patient room doors shall be lockable 

from the corridor side only; 

Outside wall corners shall be omitted 

where possible; 

The ceiling shall be of monolithic 

construction and the air distribution 

devices, lighting fixtures, sprinkler 

heads, and other appurtenances shall be 

of the security type; 

Oxygen and suction outlets are not 

required; 

All windows shall have security screens 

or be designed to prevent escape and 

shall be openable without keys or tools; 

and 

Each patient room shall be provided 

with a private toilet that meets the 

following requirements: 

The door shall not be lockable; 

The door shall be capable of swinging 

outward; 

Where provided, electrical outlets 

shall be protected by ground fault 

interrupting devices; and 

A nurse call system is not required 

where the documented programmatic 

demands of the facility prohibit its 

use. 
The service areas noted in Rule .6201 of 
this Section and the following shall be 
provided: 
(a) Consultation room; 
fb) Examination and treatment room for 
exclusive use of the psychiatric unit 
located within the unit; 
(c) A conference room for exclusive use of 
the psychiatric unit located within the 
unit; 

Space for dining and recreation with a 
total area of 35 square feet per patient; 
Storage closets or cabinets for 
recreational and occupational therapy 
equipment; and 

Storage facilities for patients' personal 
effects. 



£iy] 



£21 



id] 
£g) 

m 



Statutory Authority G.S. 131E-79. 

.6206 SURGICAL DEPARTMENT 
REQUIREMENTS 

(a) Each o perating room shall have an 



operating suite control station 
fb) A separate room for post-anesthesia recovery 



of surgical patients shall be provided. This space 
shall be arranged to provide and include direct 
observation of all patients, medicine dispensing 
facilities, hand washing facilities, charting 



facilities, flushing device, and storage space for 
su pplies and equipment. A toilet room for nursing 
staff with water closet and lavatory shall be 
provided adjacent to recovery room. Provisions 



shall also be made for observation and isolation of 
infectious patients. 

(c) Service areas shall be provided in individual 
rooms when so noted; otherwise, alcoves or other 
open space which will not interfere with traffic 
may be used. Services, except for the soiled 



workroom and the janitor's closet, may be shared 
with and organized as a part of the obstetrical 
facilities. The following service areas shall be 
provided: 

(1) An operating suite control station. The 
station shall be located to permit visual 
surveillance of all traffic which enters 



121 
£3} 



141 
151 



the operating suite or provisions shall 

be made to prevent unauthorized entry 

into the suite; 

Supervisor's office or station; 

Sterilizing facilities with a high speed 

autoclave located to serve the operating 

rooms; 

Medicine dispensing facilities; 

Scrub stations adjacent to each 

operating room and arranged to 

minimize any incidental splatter on 

nearby personnel or supply carts. A 

minimum of two scrub sinks per 

operating room shall be provided. 

Facilities with no more than three 

operating rooms may reduce the 

number of scrub sinks to four; 

A soiled workroom containing a 

flushing device, a work counter, and a 

sink equipped for hand washing; 

A soiled linen holding room with a sink 

equipped for hand washing. This 

service may be combined with soiled 

workroom and/or trash holding room; 

(8) A trash holding room with a sink 
equipp ed for hand washing. This 
service may be combined with the 
soiled workroom and/or soiled linen 
holding room; 

(9) Clean workroom or clean supply room 
when clean materials require assembly 



(6} 

01 



1836 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



prior to use and this assembly is 
performed within the surgical suite. 
This room shall contain a work counter, 
a sink equipp ed for hand washing and 
space for clean and sterile supplies. A 
clean su pply room shall be provided 
when the program defines a system for 
the storage and distribution of clean and 
sterile supplies which would not require 
the use of a clean workroom; 

(10) Anesthesia storage. If facility bylaws 
do not prohibit flammable anesthetics, 
a separate room shall be provided for 
storage of flammable gases; 

(11) Anesthesia workroom with a work 
counter and sink for cleaning, testing, 
and storage of anesthesia equipment; 

(12) A room for storage of medical gas 
reserve cylinders; 

(13) Equipment storage room for equipment 
and supplies used in surgical suite: 

(14) Staff clothing change areas appropriate 
for male and female personnel working 
within the surgical suite. These areas 
shall contain lockers, showers, toilets, 
lavatories, and space for donning scrub 
suits and boots. These areas shall be 
arranged to provide a one-way traffic 
pattern so that personnel entering from 
outside the surgical suite can change, 
shower, gown and move directly into 
the surgical suite; 

(15) Patients' holding area to accommodate 
stretcher patients waiting for surgery. 
This waiting area shall be under the 
visual control of operating room staff 
and shall be in a room or in an alcove 
out of the direct line of normal traffic; 

(16) Storage area for stretchers out of the 
corridor width; 

(17) Staff lounges and toilet facilities for 
staff located to facilitate use without 
leaving the surgical suite; and 

(18) Janitors' closet containing a floor 
receptor or service sink and storage 
space for housekeeping su pplies and 
equipment for the exclusive use of the 
surgical suite. 

Statutory Authority G.S. 131E-79. 

6207 OUTPATIENT SURGICAL 
FACILITIES 

(a) When a facility elects to share outpatient 
surgical facilities with inpatient surgical facilities. 



the outpatient operating room and support areas 
shall meet the same physical plant requirements as 
inpatient, general operating rooms and su pport 
areas. 

(b) When a facility elects to provide separate, 
non-sharable outpatient surgical facilities, the 
operating rooms and support areas shall meet the 
physical plant construction requirements of 
Outpatient Surgical Licensure requirements of 10 
NCAC 30 .1400. 

Statutory Authority G.S. 131E-79. 

.6208 OBSTETRICAL DEPARTMENT 
REQUIREMENTS 

(a) The obstetrical unit shall be located so as to 
prevent unrelated traffic through the unit and to 
provide for every reasonable protection of mothers 
from infection and from cross-infection. 

(b) The standards of the American College of 
Obstetricians and Gynecologists as outlined in the 
most current edition of the "Standards for 
Obstetric-Gynecologic Services" shall be used as a 
guide. 

(c) An emergency communication system 
connected to the operations and control station 
shall be provided by the facility. 

(d) Resuscitation facilities for neonates shall be 
provided within the obstetrical unit and convenient 
to the delivery room. 

(e) A labor room shall be provided and shall 
meet the following requirements: 

(1) A minimum of 80 sg^ fL of area shall 
be provided per labor bed; 

(2) The labor rooms shall be located so as 
to permit visual observation of each 
room from the nurses' work station; 

(3) Labor rooms shall afford privacy, and 
shall be conveniently located with 
reference to the delivery room; 

(4) If labor rooms also serve as birthing 
rooms, they shall be equipped to handle 
obstetric and neonatal emergencies; 

(5) A labor room shall contain facilities for 
medication, hand washing, charting, 
and storage for supplies and equipment; 

(6) At least one shower with direct access 
from within the delivery unit shall be 
provided; 

(7) At least two labor beds with adjacent 
toilet shall be provided for each 
delivery room; and 

(8) No more than two labor beds may be 
located in one labor room. 

(f) A toilet with hand-washing facilities shall be 



NORTH CAROLINA REGISTER 



February 1, 1995 



1837 



PROPOSED RULES 



= 



provided for the staff. 

(g) A separate recovery room may be omitted in 
facilities with less than 1500 births per year. 
When provided, the recovery room shall meet the 
following requirements: 

(1) A recovery room shall contain not less 
than two beds and shall have charting 
facilities located so as to permit visual 
observation of all beds; 

(2) Provisions for medicine dispensing, 
hand washing, clinical sink with bedpan 
washer, and storage for supplies and 
equipment shall be provided; and 

(3) A toilet with hand washing facilities 
shall be provided for staff. 

(h) When a facility elects to provide labor, 
delivery and recovery room (LDR) service as a 
part of its total services, the following 
requirements shall be met: 

(1) Each labor, delivery and recovery room 
shall have a minimum of 250 square 
feet of floor space exclusive of toilet 
room, closet, or vestibule; 

(2) A toilet directly accessible from each 
labor, delivery and recovery room shall 
be provided for use by that room only 
and equipped with a clinical sink or 
other suitable flushing device for 
emptying bed pans; 

(3) Each labor, delivery and recovery room 
shall be provided with directly 
accessible shower for use by that room 
only; 

(4) Each labor, delivery and recovery room 
shall be equipped with oxygen, suction, 
medical air, and electrical outlets; and 

(5) Each labor, delivery and recovery room 
shall contain facilities for medication, 
hand washing, charting, and storage for 
supplies and equipment. 

£i) When a facility elects to provide labor, 
delivery, recovery and postpartum (LDRP) service 
as a part of its total services the following 
requirements shall be met: 

(1) Each labor, delivery, recovery and 
postpartum room shall meet the 
requirements listed in Rule .6208 (h) of 
this Section; and 

(2) Each labor, delivery, recovery and 
postpartum room shall be counted as a 
single patient room for purposes of 
determining the facility's bed capacity. 

(j) The following shall be provided: 
(1) If analgesia is used, beds shall be 
equipped with side rails; and 



(2) There shall be facilities for examinatio 
and preparation of patients as 
by the attending physician. 
(k) The obstetrical (OB) unit shall be provide 



with the following services either in individu; 



rooms, alcoves, or other open spaces not subject t 
traffic: 

Scrub facilities with stations locate* 



in 



adjacent to each pair of delivery room 
and arranged to minimize incidenta 



12] 



splatter on nearby personnel or suppl; 

carts; 

A storage room for equipment anc 

supplies; 

One delivery room with suppor 



services meeting the requirements of 
surgical operating room and suppor 
services referenced in Rule .6206 p_ 
this Section if caesarean sections are tc 
be performed in the obstetrical deliver, 
unit; and 



£41 



One janitor's closet exclusively for us* 
by the obstetrics unit. 
(1) The obstetrical unit shall be provided with 



the following services either in individual rooms 



alcoves, or other open spaces not subject to traffic, 
however, they may be located either in the 



obstetrics unit or may be shared with the surgical 
unit if arranged so as to avoid cross traffic 
between the surgical and obstetrics units: 



in 



m 

121 
141 



Delivery unit control station located so 
as to permit visual surveillance of all 
traffic which enters the obstetrical unit 
Supervisor's office or station; 
Medicine dispensing facilities; 
Scrub facilities with stations located 



adjacent to each pair of delivery rooms 
and arranged so as to minimize 



151 



incidental splatter on nearby personnel 

or supply carts; 

Soiled workroom or a soiled holding 

room as a part of a system for the 

collection and disposal of soiled 

materials: 



1A1 



mi 



A soiled workroom may not be shared 
with the surgical unit and shall 
contain a flushing device, a work 
counter and sink equipped for hand 
washing, a waste receptacle, and a 
linen receptacle; and 
A soiled holding room may be shared 



with the surgical unit and shall be 
similar to the soiled workroom except 
that the flushing device and work 
counter may be omitted. 



1838 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



£6} 



01 
£9} 



£A} 



im 



(10) 

an 

(12) 
(13) 



Fluid waste disposal facilities 
convenient to the delivery rooms; the 
flushing device in a soiled workroom 
meets this requirement; 
Staff clothing change areas a ppropriate 
for male and female personnel working 
within the obstetrics unit including 
lockers, shower, toilet, and lavatory, 
and space for donning scrub suit and 
boots; 

Lounge and toilet facilities for 
obstetrical staff; 

Stretcher storage provisions out of 
direct line of traffic; 
Clean workroom, or clean supply 
room: 
A clean workroom or supply room is 
required when clean materials require 
assembly prior to use and this 
assembly is performed within the 
obstetrics unit; and 
Clean workroom shall contain a work 
counter, a sink equipped for hand 
washing, and space for clean and 
sterile su pplies; 
Anesthesia workroom for the cleaning, 
testing, and storage of anesthesia 
equipment with a work counter and 
sink; 

Space for storage of nitrous oxide and 
oxygen cylinders; 

A storage room for equipment and 
supplies used in a surgical unit; 
Delivery room(s) used for no other 
purpose than for the completion of 
labor and delivery and including a 
minimum clear area of 300 square feet, 
exclusive of fixed and movable cabinets 
and shelves. The minimum room 



(14) One 



di mension shall be 16 feet 
room 



and 



One delivery room meeting the 
following requirements if caesarean 
sections are to be performed in the 
obstetrics unit: 

(A) The delivery room shall meet the 
requirements for surgical operating 
rooms: and 

(B) Su pport services required for surgical 
operating rooms shall be provided. 

Statutory Authority G.S. 131E-79. 

.6209 EMERGENCY SERVICES 

(a) The minimum requirements for emergency 
care required under Section .4100 of this 



Subchapter shall determine the type facilities to be 
provided. 

(b) When a facility provides emergency services 
under one of the classifications listed in Section 
.4100 of this Subchapter, the following shall be 
provided: 

01 Level I. II, HI: 

(A) a drive at grade level with provision 
for ambulance and pedestrian service 
and a well marked covered entrance 
with a minimum clear passage height 
of J2 feet 8 inches and a clear width 
of 16 feet; 

(B) public waiting space with toilet facili- 
ties, telephone, drinking fountain, 
stretcher, and wheelchair storage; 

(C) nurses' work and charting space shall 
be provided. This may be combined 
with reception and control area for 
Level HI; 

(D) storage for clean supplies and equip- 
ment. Facilities shall be available for 
the administration of blood, blood 
plasma, and intravenous medication as 
well as for the control of bleeding, 
emergency splinting of fractures, and 
the administration of oxygen, anesthe- 
sia, and suction; 

soiled holding area with flushing 
device; 






12) 



janitor's closet with service sink; 
patient toilets; and 
staff toilets. 
Level I. II: 



(A) a reception and control area that is 
staffed around the clock; 
visual control of the entrance, waiting 
room, and treatment area shall be 



£B) 
£D) 



maintained; 

communication with other facility 

departments; 

at least one treatment room shall be 

available around the clock for the 

examination and initial treatment of 

emergency patients. This room shall 

be independent of the operating room; 



(E) treatment rooms or areas shall contain 
cabinets, medication storage, work 
counters. X-ray film illuminators, and 
space for storage of emergency equip- 
ment; 

(F) the size of the rooms or areas shall 
allow for a minimum of 3 feet clear 
on three sides of each stretcher; and 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1839 



PROPOSED RULES 



(G) hand washing facilities shall be 
provided. 

Statutory Authority G.S. 131E-79. 

.6210 IMAGING SERVICES 

Imaging services include fluoroscopy, 
radiography, mammography, computerized 
tomography scanning, ultrasound, magnetic 
resonance, angiography and other similar 
techniques. 

(1) Radiology services are required for all 
facilities and shall contain the following: 

(a) Radiographic and fluoroscopic rooms; 

(b) Film processing equipment; 

(c) Administration and viewing areas; 

(d) Provisions for film storage; 

(e) Toilet room with hand washing 
facilities immediately accessible to each 
fluoroscopy and radiography room; 

(f) Dressing area with immediate access to 
toilets; 

(g) Waiting room or alcove for patients; 
(h) Holding area for stretcher patients out 

of corridor width; and 
£i] A shielded control alcove with a view 

window for full view of patient. 

(2) Angiography services are not required for 
licensure; however, when this service is 
provided it shall have the following: 

(a) Procedure room sized to accommodate 
and service the equipment purchased 
but having a minimum area of 400 
square feet; 

(b) A control room with a view window 
that permits a full view of the patient; 

(c) A designated radiographic view area 
having a minimum length of 10 feet 
(3.05 meters'): 

(d) Scrub sink outside staff entrance to the 
procedure room; 

(e) Patient holding area large enough to 
accommodate two stretchers out of the 
corridor width; 

(f) Storage area for portable equipment and 
supplies out of the corridor width; and 

(g) Post procedure observation area for 
patients. 

(3) Computerized Tomography (CT) 
Scanning service is not required for 
licensure; however, when this service is 
provided, the following shall be 
provided: 

(a) Procedure room sized to accommodate 
and service the equipment purchased; 



(Si 

£di 

isH 

141 



Control room with a view window tc 

permit full view of the patient; 

Film processing area adjacent to th< 

control room; 

Patient toilet accessible to the procedun 



room located to permit the patient t< 
exit the toilet without reentering thj 
procedure room; and 
At least one emergency light located ii 
the procedure room. 
Magnetic Resonance Imaging ("MRI 



service is not required for licensure 



however, when this service is provided 

the following shall be provided: 

Procedure and support rooms sized tc 

accommodate and service the equipmen 



purchased; 
A control room with full view of thj 
patient and MRI unit and having 
minimum area of 100 square feet; 
A patient holding area located near thj 
MRI unit and large enough 



accommodate stretchers 
corridor width; 



out of thj 



(d) Patient toilet accessible to the procedun 



room and located to permit the patien 



£5} 



to exit the toilet without reentering thj 

procedure room; and 

At least one emergency light located u 

the procedure room. 
Design and performance specification! 
related to the radiation shielding o 
imaging rooms shall be furnished by ; 
qualified physicist approved by thj 
Radiation Protection Division of the N.C 



Department of Environment Health ant 
Natural Resources. 

Statutory Authority G.S. 131E-79. 

.6211 LABORATORY SERVICES 

Laboratory services may be provided within thj 
facility or through contract with a laboratory 
service. If laboratory services are offered withii 



the facility, then the following shall be provided: 

(1) Laboratory work counter with sink 

vacuum, gas and electrical outlets; 

Lavatory or counter sinks equipped fo 

hand washing; 

Blood storage equipment witl 
temperature monitoring and alani 



£2) 
£3} 



ID 

la) 



signals; and 
Specimen collection: 
Urine collection rooms 



shall tx 



equipped with a water closet anc 



1840 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



lavatory; and 
(b) Blood collection area shall have space 
for a chair, work counter, and hand 
washing sink. 

Statutory Authority G.S. 131E-79. 



.6212 MORGUE 

(a) Where facilities 



have an agreement to 



transfer bodies within six hours of death, a single 
room large enough to contain a stretcher is 
acceptable. 



(b) When autopsies are conducted at the facility, 
the morgue shall be directly accessible to the 
service entrance or an outside entrance, and shall 
be located to avoid movement of bodies through 
lobbies and other public areas. The following 



£21 



elements shall be provided: 

(1) Refrigeration equipment for body- 
holding; and 

Autopsy room containing: 
Work counter with sink equipped for 
hand washing; 

Storage space for supplies, 
equipment, and specimens; 
Autopsy table; 

A deep sink for washing of 
specimens; 

Clothing change area with shower, 
toilet, and lockers; and 
(F) Janitor's closet with service sink or 
receptor. 
(c) Where no transfer agreement exists with 
another facility, or bodies cannot be transferred 
within six hours or autopsies are not conducted at 
the facility, a well ventilated, temperature 
controlled body-holding room shall be provided. 



£A1 

£Q 

£D1 



Statutory Authority G.S. 131E-79. 

.6213 PHARMACY SERVICES 

The size of the pharmacy and the type of 
services to be provided in the pharmacy will 
depend upon the facility mission statement, the 
type of drug distribution system to be used in the 
facility, and the extent of shared or purchased 
services. When pharmacy services are planned, 
provisions shall be made for the following: 
(1) Administrative functions including pick- 
up and receiving, requisition processing, 
drug information and storage for general 
supplies, volatile fluids and alcohol; 
Quality control area with sufficient 
counter space when bulk compounding 
and packaging functions are performed; 



12) 



(3) Secure storage for controlled substances; 

(4) An area for temporary storage, exchange 
and restocking of carts; and 

(5) Hand washing facilities within each 
separate room where open medication is 
handled. 

Statutory Authority G.S. 131E-79. 

.6214 DIETARY SERVICES 

(a) Construction, equipment, and installation 
shall comply with the standards of the N.C. 
Department of Environment, Health and Natural 
Resources. 

(h) The following shall be provided to 
implement the type of food service system outlined 
in the hospital's mission statement: 

(1) Control station for receiving food 
supplies: 

(2) Space for four days' food supply 
including refrigeration space is required 
for a conventional food preparation 
system ; 

(3) Food preparation space for conventional 
food preparation equipment needed in 
preparing, cooking, and baking foods; 
convenience food service systems 
(frozen prepared meals, bulk packaged 
entrees, individual packaged portions, 
etc.) or systems utilizing contractual 
commissary services require space and 
equipment for thawing, portioning, 
cooking and baking. In addition, a 
lavatory shall be provided in the food 
preparation area; 

Tray assembly and distribution space; 
Dining space for ambulatory patients, 
staff, and visitors; 
Dietary office; 

Locker room and toilet facilities for 
dietary staff; 

Storage space for housekeeping 
equipment and supplies located within 
the dietary department, including a 
floor receptor or service sink; and 
Ice making equipment convenient to 
salad preparation area and cafeteria. 



£41 
15} 

£61 

£21 

£81 



£91 



Statutory Authority G.S. 131E-79. 

.6215 ADMINISTRATION 

(a) The facility entrance shall be at grade level, 
sheltered from the effects of inclement weather, 
and able to accommodate wheelchairs and 
stretchers. 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1841 



PROPOSED RULES 



(b) The entrance lobby shall contain: 
(1) Reception and information counter or 
desk; 



131 



141 

151 
161 



Waiting space; 

Storage area(s) for wheelchairs and 

stretchers; 

Public toilets; 



Public telephone; and 
Drinking fountain. 

(c) Private interview space shall be provided. 

(d) Office spaces for administrative staff shall be 
provided. 

(e) Medical library shall be provided. 
ifj Staff toilets shall be provided. 

(e.) Storage for office equipment and supplies 
shall be provided. 

(h) A janitor's closet containing a floor receptor 
or service sink and storage space for housekeeping 
equipment and supplies shall be provided. 

Statutory Authority G.S. 131E-79. 

.6216 MEDICAL RECORDS SERVICES 

Medical records services shall include the 
following: 
(1) Medical record director's office or space; 
121 A separate review and dictating room; 

(3) Work area for sorting, recording, or 
microfilming records; 

(4) Storage area for records; and 

(5) An approved smoke detection system, 
interconnected with the facility fire alarm 
system if medical records are stored in a 
separate building. 

Statutory Authority G.S. 131E-79. 

.6217 CENTRAL MEDICAL AND 

SURGICAL SUPPLY SERVICES 

(a) A separate receiving room shall be provided 
and shall contain work space and equipment for 
initial sterilization and disinfection of medical and 
surgical equipment and for disposal or processing 
of unclean articles. Hand washing facilities shall 
be provided. 

(b) A separate clean workroom shall be 
provided and shall contain work space and 
equipment for sterilizing medical and surgical 
equipment and supplies. Storage areas for clean 
supplies and for sterile supplies shall be included 
in this room. 

(c) A separate storage room for assembly, final 
packaging, and storage of sterile supplies and 
equipment shall be provided. 

(d) A storage room for unsterile supplies and 



equipment shall be provided but may be located in 
another area of the facility. 

(e) Provisions shall be made for cleaning and 
sanitizing carts serving the central supply services, 
dietary services, and linen services departments 
and may be centralized or departmentalized . 

Statutory Authority G.S. 131E-79. 

.6218 GENERAL STORAGE 

General storage room(s) shall have a total area of 
not less than 20 square feet (1.86 square meters) 
per inpatient bed and shall be concentrated in one 
area but may be divided in a multiple building 
complex and shall include: 

(11 Receiving area; and 

121 Off street loading area. 

Statutory Authority G.S. 131E-79. 

.6219 LAUNDRY SERVICES 

(a) When the facility elects to provide its own 
laundry, the laundry shall contain the following: 
(1) A soiled linen holding room; 
121 A designated clean linen storage area 

unless a closed linen cart system is 

utilized; 
(3) A linen cart cleanup and storage area: 
141 Toilet facilities accessible to employees 

from soiled linen, clean linen, and 

laundry processing; 

(5) Laundry processing area with hand 
washing facilities and commercial type 
equipment which can process seven 
days' needs within a scheduled work 
week; 

(6) A janitor's closet containing a floor 
receptor or service sink and storage 
space for housekeeping equipment and 
supplies; and 

(7) Supply storage. 

Cb) When the facility elects to contract for 
laundry service off premises it shall provide the 
following: 

(1) Soiled linen holding room; 
(21 Clean linen holding room; 

(3) Linen cart cleanup and storage room; 
and 

(4) Hand washing facilities. 

Statutory Authority G. S. 131E-79. 

.6220 PHYSICAL REHABILITATION 
SERVICES 

When physical rehabilitation services are offered 



1842 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



in the 
01 

m 

£3} 
14} 
(51 



16} 

m 



18} 
(9} 



facility, the following shall be provided: 
Patient waiting space, with provisions for 
wheelchair patients and stretcher patients; 



Office space; 
Patients' toilet; 



Hand washing facilities: 

Treatment areas or room that provides 

visual privacy (visual privacy not 

required for Occupational Therapy and 

Speech Therapy); 

Soiled linen storage (not required for 

Occupational Therapy and Speech 

Therapy); 

Clean linen 

Occupational 

Therapy); 

Equipment storage; and 

Wheelchair and stretcher storage- 



storage (not required for 
Therapy and Speech 



Statutory Authority G.S. 131E-79. 

.6221 ENGINEERING SERVICES 

The following provisions for engineering services 
shall be included: 
(1) A room or separate building for boilers, 

mechanical equipment, and electrical 

equipment; 
{2} Office; 

(3) Maintenance shop; 

(4) Maintenance supplies storage room; and 

(5) Locker and toilet rooms for engineering 
service employees. 

Statutory Authority G.S. 131E-79. 

.6222 WASTE PROCESSING 

Each facility shall provide for the processing and 
disposing of all waste products in accordance with 
local city and county requirements and the 
requirements of the N.C. Department of 
Environment Health and Natural Resources and 
shall produce evidence of approval from each 



key in any emergency; 

(2) Doors in all openings between corridors 
and rooms or spaces subject to 
occupancy shall be of the side hinged 
type or an approved sliding type door; 

(3) No doors shall swing into corridors in 
a manner that might obstruct traffic 
flow or reduce the required corridor 
width except for doors to spaces such 
as closets less than 25 square feet in 
floor area, which are not subject to 
occupancy; 

(4) Grab bars shall be provided at all 
patient toilets, showers, and tubs. Grab 
bars shall have not less than 2-1/2 inch 
clearance to the wall or support and 
shall be capable of supporting not less 
than a 250 pound concentrated load; 

(5) Single use soap dispensers, towel 
dispensers or air driers shall be 
provided at all hand washing fixtures 
except scrub sinks; 

(6) All rooms shall have not less than 8 
foot high ceilings except that ceilings of 
corridors, storage rooms, toilet rooms, 
and other minor rooms shall be no less 
than 7 feet 6 inches high. Suspended 
tracks, rails, pipes, etc., located in the 
path of normal traffic, shall be no less 
than 7 feet 6 inches above the floor; 

(7) Rooms containing equipment shall be 
insulated and/or ventilated to prevent 
any patient use floor surface above 
from exceeding a temperature 10 
degrees F above the ambient room 
temperature; and 

(8) Approved fire extinguishers shall be 
provided throughout the building to 
comply with National Fire Protection 
Association Standard 10. 

Finishes shall meet the following 



authority having jurisdiction prior to the start of 
facility operation. 



Statutory Authority G.S. 131E-79. 

.6223 DETAILS AND FINISHES 

(a) All details and finishes for modernization 
projects as well as for new construction shall meet 
the following requirements: 

(1) All rooms containing baths, showers, 
and toilets. subject to patient 
occupancy, shall be equipped to open 
from the outside without the use of a 



{b} 

requirements: 
(1) Floors 



in 



areas used for food 



121 



preparation or food assembly shall be 
water, oil and slip resistant. Joints in 
tile and similar material in such areas 
shall be resistant to food acids. In all 
areas subject to frequent wet cleaning, 
floors shall not be physically affected 
by germicidal and cleaning solutions- 
Floors that are subject to traffic while 
wet, as in kitchens, showers, and bath 
areas and similar work areas, shall have 
a non-slip surface; 
Floors and wall bases in operating and 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1843 



PROPOSED RULES 



flo 



delivery rooms shall be joint free. 
Wall bases shall be tightly sealed within 
the wall and constructed without voids 
that can harbor vermin; 

(3) Floors and wall bases in kitchens, 
soiled workrooms, and other areas 
subject to frequent wet cleaning, shall 
be made integral with the floor, tightly 
sealed to the wall, and constructed 
without voids that can harbor vermin; 

(4) Walls shall be washable. In the 
immediate area of plumbing fixtures, 
the finish shall be smooth, moisture 
resistant, and easily cleanable; 

(5) Floor and wall penetrations and joints 
of structural elements shall be tightly 
sealed to minimize entry of rodents and 
insects; 

(6) Ceilings throughout shall be easily 
cleanable. Those in operating and 
delivery rooms, nurseries, and other 
sensitive areas shall be readily washable 
and without crevices that can retain dirt 
particles. These sensitive areas along 
with the dietary and food preparation 
areas shall have a finished ceiling 
covering all overhead ductwork, etc. 
Finished ceilings may be omitted in 
mechanical and equipment spaces, 
shops, general storage areas, and 
similar spaces except where required 
for fire rating; 

(7) In psychiatric patient rooms, toilets, 
and seclusion rooms, the ceiling shall 
be of monolithic construction. Air 
distribution devices, lighting fixtures, 
sprinkler heads, and other appurtenanc- 
es shall be of the security type. All 
windows shall have security screens or 
be designed to prevent escape and shall 
be openable without keys or tools; 

(8) Rooms used for protective isolation 
shall not have carpet. Ceilings shall be 
of monolithic construction; and 

(9) Rooms where impact noises are gener- 
ated shall not be located directly over 
or under patient bed areas, and delivery 
or operating suites unless special provi- 
sions are made to minimize noise. 



Statutory Authority G.S. 131E-79. 

.6224 ELEVATOR REQUIREMENTS 

Elevators shall meet the following: 

(1) Facilities with patient areas located on 



other than the grade-level entrance 
shall have at least one hospital-tvpe el 
vator; 

(2) In the absence of an engineered trafi 

study, the following guidelines for nui 

ber of elevators shall a pply: 

(a) At least one hospital-type elevator shj 

be installed when 60 patient beds i 

less are located on any floor other th 

the main entrance floor; 

fb) At least two hospital-type elevato 

shall be installed when 61 to 200 p_ 

tient beds are located on floors otb 

than the main entrance floor, or whe 



Id) 



(3) 



14) 



inpatient services are located on a floe 
other than those containing patie 
beds. Elevator service may be reduce 
for those floors providing only parti, 



Ic) At 



inpatient services; 

At least three hospital-type elevato 
shall be installed where 201 to 35 
patient beds are located on floors othj 



than the main entrance floor, or whei 



inpatient services are located on a floe 
other than those containing patiei 



beds. Elevator service may be reduce 



for those floors providing only parti; 

inpatient services; and 

For facilities with more than 350 bed; 



the number of elevators shall be deter 



mined from an engineering study of th 



facility plan and the expected vertica 

transportation requirements. 
Hospital-type elevator cars shall hav 
inside dimensions that will accommodat 



a patient's bed with attendants. Cars shal 



be at least five feet (1.52 meters) wide b 



seven feet six inches (2.29 meters) deep 



Car doors shall have a clear opening o 
not less than four feet (1.22 meters) widi 



and seven feet (2.13 meters) high; and 
Elevators, except freight elevators, shal 
be equipped with a two-way servicx 
switch for staff use for bypassing al 
landing button calls and traveling directl 
to any floor. 



Statutory Authority G.S. 131E-79. 



1844 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



.6225 MECHANICAL REQUIREMENTS 

(a) Prior to occupancy of the facility, the facility shall obtain documentation verifying that all mechanical 
systems have been tested, balanced, and operated to demonstrate that the installation and performance of these 
systems conform to the a pproved design. Test results shall be maintained in the facility maintenance files. 

(b) Upon completion of equipment installation, the facility shall acquire and maintain a complete set of 
manufacturers' operating, maintenance, and preventive maintenance instructions, parts lists, and procurement 
information including equipment numbers and descriptions. 

(c) Operating staff shall be provided with instructions for properly operating systems and equipment. 

(d) The facility structure, component parts, and building systems shall be kept in good repair and maintained 
with consideration for the safety and comfort of patients, staff and visitors. 

(e) There shall be a definite assignment of maintenance functions to qualified personnel under supervision. 

(f) General design requirements shall meet the following: 

(1) Heating plants shall be adequate to maintain a cold weather temperature of 70 degrees R (21.1 
degrees C.) in all rooms used by patients; 

(2) Boilers shall have capacity to supply all the heating functions of the facility. The number and 
arrangement of boilers shall accommodate the facility's needs despite the breakdown or routine 
maintenance of any one boiler; 

(3) Insulating materials shall be provided within the facility to conserve energy, protect personnel, 
prevent vapor condensation, and reduce unnecessary noise and vibration; 

(4) Facility design considerations shall include recognized energy saving measures. When using 
variable air volume systems within the facility special care shall be taken to assure that minimum 
ventilation rates and pressure relationships between various de partments are maintained; 

(5) The general air pressure relationships, ventilation rates, and relative humidity requirements of 
Table 1 shall be maintained; 

Table 1 

Ventilation Requirements for Areas Affecting Patient Care in Hospitals and Skilled Nursing Units and 

Outpatient Facilities in Hospitals' 



Area Designation 


Air 


Minimum 


Minimum 


All air 


Recirculated 


Relative 


Design 




movement 


air 


total air 


exhausted 


by means of 


humidity 


temperature 




relationship 


changes of 


changes 


direct hj 


room units 6 


(%)' 


£FTC^ 




to adjacent 


outdoor 


per hour 4 


to 










area 1 


air per 

hour 3 




outdoors* 








Surgery and Critical Care 
















Operating room' 


Out 


3 


IS 


. 


No 


50-60 


70-75/21-24 


Delivery room * 


Out 


4 


15 




No 


45-60 


70-75/21-24 


Recovery room ' 


= 


2 


6 


- 


No 


30-«0 


70/21 


Special care 


. 


2 


6 




No 


30-60 


70-75/21-24 


Treatment room 10 


- 


- 


6 


- 


- 


- 


75/24 


Trauma room 10 


Out 


3 


15 




No 


45-60 


70-75/21-24 


Anesthesia gas storage 


n 


:r 


8 


Yes 


~ 


Z 


~ 


NURSING 
















Patient room 


- 


1 


2 


- 


- 


- 


70-75/21-24 


Toilet room 


In 




10 


Yes 


Yes 






Newborn nursery suite 


_ 


2 


6 




No 


30-60 


75/24 


Protective isolation when provided" 


Out 


1 


6 




No 




70-75/21-24 


Infectious Isolation when provided 12 


In 


I 


6 


Yes 


No 


. 


70-75/21-24 


Isolation alcove or anteroom" n 


In/Out 




10 


Yes 


No 


- 




Labor/deli very /recovery 


-j 




2 








70-75/21-24 


Labor/ deli very/recovery /postpartum 


- 


~ 


2 


- 


- 


- 


70-75/21-24 


Patient corridor 


— 


= 


2 


= 


— 


— 


~ 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1845 



PROPOSED RULES 






ANCILLARY 

Radiology 13 

X-ray (aurg/critkal care) 

X-ray (diagnostic & treat.) 

Darkroom 
laboratory 

General" 

Biochemiatry " 

Cytology 

Glass Washing 

Histology 

Microbiology" 

Nuclear medicine 15 



Pathology 

Serology 

Sterilizing 
Autopsy room 

Non refrigerated body-holding room 15 
Pharmacy 



Out 
In 



Out 
In 

Is 

In 

Is 
Is 

In 

Out 

!s 

In 
In 



15 
6 
10 

6 
6 
6 

in 

6 
6 
6 
6 
6 
10 
12 

I« 

4 



Yes 



Yes 
Yes 
Yes 

Yes 
Yes 
Yes 

Yes 
Yes 
^es 



No 
No 



No 

No 

No 
No 
No 
No 
No 

No 
Yes 



45-60 



70-75/21-24 

75/24 



70/21 



DIAGNOSTIC AND TREATMENT 

Examination Room 

Medication room 

Treatment room 

Physical therapy and hydrotherapy 

Soiled workroom or soiled holding 

Clean workroom or clean holding 



In 
In 



6 
4 

h 
6 

10 
4 



75/24 



75/24 
75/24 



Yes 



No 



STERILIZING AND SUPPLY 
ETO-sterilizer room 1 * 

Sterilizer equipment room" 
Central medical and surgical supply 
Soiled or decontamination room 
Clean workroom and sterile storage 



Is 

In 
Out 

In 
Out 



10 
10 
6 
4 
6 



Yes 
Yes 



Yes 



No 
No 
No 



(Max) 20 



75/24 



75/24 



Area Designation 



Air 
movement 
relationship 
to adjacent 



Minimum 

air 

changes of 

outdoor 

air per 

hour 3 



Minimum 
total air 
changes 

per hour* 



All air 

exhausted 
directly 

to 
outdoors 3 



Recirculated 
by means of 
room units' 



Relative 

humidity 
(%)' 



Design 
temperature 



SERVICE 

Food preparation center 1 T 

Ware washing 

Dietary day .storage 

laundry, general 

Soiled linen (sorting and .storage) 

Clean linen storage 

Sotted linen and trash chute room 

Bedpan room 

Bathroom 

Janitor's closet 



In 



In 
In 



In 



10 

IP. 
2 
10 
10 
2 

10 
10 
10 
10 



Yes 



Ye« 
Yea 



Yes 
Ye* 



Yes 



No 
No 



No 



No 
Yea 



No 



75/24 



Table Notes: 



The ventilation rates in this table cover ventilation for comfort, as well as for asepsis and odor control in areas of acute care hospitals that direct 1; 



affect patient care and are determined based on health care facilities being predominantly "No Smoking" facilities. Where smoking may b e allowed 



ventilation rates will need adjustments. Specialized patient care areas, including o rftan t ransplant units, burn unit^ specialty procedure rooms, etc 



shall have additional ventilation provisions for air quality control as may be appropriate, 

2 Design of the ventilation system shall provide that air movement js from "clean to less clean" areas. However, continuous compliance may b 



impractical with full utilization of some forms of variable air volume and load shedding systems that may be used for energy conversation. Areas thai 
do require positive and continuous control are noted with "Out" or "In" to indicate the required direction of air movement in relation to th e space named. 



Rate of air movement may, of course, be varied as needed wit hin the limits required for positive control. Where indication of air movement direction 



is enclosed in parentheses, continuous directional control is required only when the specialized equipment or device is in use or where room use may 



otherwise compromise the Intent of movement from clean to less clean. Air movement for rooms with dashes and non-patient areas may vary ju 
necessary to satisfy the requirements of those spaces. Additional adjustments may be needed when space js unused or unoccupied an d air systems are 
de-energized or reduced. 

3 Jo satisfy exhaust needs, replacement air from outside is necessary. Table I does not attempt to describe specific amounts of outside air to be 
supplied to individual spaces except for certain areas such as those listed. Distribution of the outside air, added to the system to balance required 
exhaust, shall be as required by good engineering practice. 

4 Number of air changes may be reduced when the room is unoccupied if provisions are made to ensure that the number of ah - changes indicated 



is reestablished any time the space is being utilized. Ad justments shall include provisions so that the direction of air movement shall remain the same 



when the number of air changes is reduced. Areas not indicated as having continuous directional control may have ventilation systems shut down when 

space is unoccupied and ventilation is not otherwise needed 

5 Air from areas with contamination and/or odor problems shall be exhausted to the outside and not recirculated to other areas. Note that individual 



1846 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



cjremnrtanceg may require special consideration for air exhaust to outside, e.g., in intensive care unit in which patienta with pulmonary infection are 
treated, and rooms for burn patients. 

6 Because of cleaning difficulty and potential for buildup of contamination, recirculating room units shall not be used in areas marked "No." 
Isolation and intensive care unit rooms may be ventilated by reheat induction units in which only the primary air supplied from a central system passes 
through the reheat unit. Gravity -type heating or cooling units such as radiators or connectors shall not be used in operating; rooms and other special 
care areas. 

7 The ranges listed are minimum and maximum limits where control is specifically needed. 

8 Dual temperature indications (such as 70-75/21-24) are for an upper and lower variable range at which the room temperature shall b e controlled. 
A single figure indicates a heating or cooling capacity of at least the indicated temperature. This is usually applicable w he n patients may be undressed 
and require a warmer environment. Nothing in these rules shall be construed as precluding the use of temperatures lower than those noted when the 
patients' comfort and medical conditions make lower temperatures desirable. Unoccupied areas such as storage rooms shal l have temperatures 
appropriate for the function intended. 

9 For Information Only - National Institute of Occupational Safety and Health (NIOSH) Criteria Documents regarding Occupational Exposure to 
Waste Anesthetic Gases and Vapors, and Control of Occupational Exposure to Nitrous Oxide indicate a ne ed for both local exhaust (scavenging) systems 
pnH general ventilation of the areas in which the respective gases are utilized. 

10 The term trauma room as used here is the operating room space in the emergency department or other trauma reception area that is used for 
emergency surgery. The first aid room and/or "emergency room" used for initial treatment of accident victims may be ventilated as noted for the 
"treatment room." 

11 The protective isolation rooms described in these rules are those that might be utilized for patients with a high susceptibility to infection from 
leukemia, burns, bone marrow t ransplant, or acquired immunodeficiency syndrome and that require special consideration for which air movement 
relationship to adj acent areas would be positive rather than negative. For protective Isolation the patient room ah all be positive to both anteroom and 
toilet. Anteroom shall be neutral to corridor. Where requirements for both infectious and protective isolation are reflected in the anticipated patient 
load, ventilation shall be modified as necessary. Variable su pply air and exhaust systems that allow maximum isolation room space flexibility with 
reversible air movement direction would be acceptable only if appropriate adjustments can be ensured for different types of isolation occupancies. 
Control of the adjustments shall be under the supervision of the medical staff. 

12 The infectious isolation rooms described in these rules are those that might be utilized in the average community hospital. The assumption is made 
that most isolation procedures will be for infectious patients and that the room is suitable for normal private patient use when not needed for isolation. 
This compromise obviously does not provide for ideal isolation. The design shall consider t ypes and numbers of patients who might need this separation 
within the facility. Isolation room shall be negative to anteroom and positive to toilet. Anteroom shall be neutral to corridor. 

13 Large hospitals may have separate departments for diagnostic and therapeutic radiology and nuclear medicine. For specific information on 
radiation precautions and handling of nuclear materials, refer to appropriate sections of requirements developed by the Division of Radiation Protection, 
NCDEHNR. 

14 When required, appropriate hoods and exhaust devices for the removal of noxious gases shall be provided. 

15 A non- refrige rated body-holding room would be applicable only for health care fa cilities in which autopsies are not performed on-site, o r the space 
is used only for holding bodies for short periods prior to t ran sfer ring. 

16 For Information Only - Specific OSHA regulations regarding ethylene oxide (ETO) use have been promulgated. 29CRF Part 1910. 1047 includes 
specific ventilation requirements including local exhaust of the ETO sterilizer area. 

17 Food preparation centers shall have an excess air supply for "out" air movements when hoods are not in operation. The number of air changes 
may be reduced or varied to any extent required for odor control when the space U not in use, 

(6) Air duct liners exposed to the air stream shall not be used in ducts serving special care areas or 
special procedure rooms when such liners are constructed with frangible materials that will enter 
the air stream; 

(7) All central ventilation or air conditioning systems shall be equipped with filters with efficiencies 
equal to, or greater than, those specified in Table 2^ Where two filter beds are required, filter bed 
No. 1 shall be located upstream of the air conditioning equipment and filter bed No. 2 shall be 
downstream of any fen or blowers. A manometer shall be installed across each filter bed having 
a required efficiency of 75 percent or more; 

Table 2 

Filter Efficiencies for Central Ventilation and Air 

Conditioning Systems in General Hospitals 



Area Designation 



No. filter beds 



Filter bed No. 1 



Filter bed No. 2 



All areas for inpatient care, treatment, and 
diagnosis, and those areas providing direct 
service or clean su pplies such as sterile and 
clean processing, etc. 



25 



90 



Protective isolation room when used 



25 



99.7 



Laboratories 



80 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1847 



PROPOSED RULES 








Administrative, bulk storage, soiled holding 
areas, food preparation areas, and laun- 
dries 


1 


25 





Any system utilized for occupied areas shall include provisions to avoid air stagnation in interio 
spaces where comfort demands are met by temperatures of surrounding areas; 
All rooms and areas in the facility used for patient care shall have provisions for year roum 
mechanical ventilation; 

Each patient's room shall have at least one openable window, opening to the outside to permi 
ventilation; and 
(1 1) In psychiatric units, all convectors, HVAC enclosures, or air distribution devices that are expose< 



181 

121 

(10) 



in the room shall be constructed with rounded corners and shall be fastened with tamper-prool 
screws, 
(g) Mechanical air intakes shall meet the following: 
(1) Air intakes shall be located as far as practical but not less than 30 feet (9.14 m.) from exhaus 






outlets of combustion equipment stacks, ventilation exhaust outlets from the facility or adjoinin g 



buildings, medical-surgical vacuum systems or areas that may collect vehicular exhaust or othei 
noxious fumes; and 



111 



The bottom of the outdoor air intakes shall be at least 6 feet (1.83 m.) above ground level, or jl 
installed above the roof, at least 3 feet (.91 m.) above roof level. 
(h) Mechanical air exhaust/ ventilation systems shall meet the following: 

(1) Fans serving exhaust duct systems shall be located at the discharge end of the duct and shall be 
readily accessible for servicing; and 

(2) Exhaust outlets shall be located a minimum of 10 feet (3 m.) above ground and directed away from 



occupied areas, doors, or openable windows. Prevailing winds, adjacent buildings, and discharge 

velocities shall be taken into account when designing such outlets. 

(i) Surgery and special care areas shall meet the following: 

(1) All air shall be supplied at or near the ceiling and removed from at least two remote locations near 

the floor; 



121 
ill 



Bottom of exhaust or return registers shall be no less than 3 inches (7.62 cm.) above the finished 
floor level; and 



Exhaust grilles for anesthesia evacuation and other special applications shall be permitted to be 
installed in the ceiling. 
(jl Nursery, labor, delivery, recovery, postpartum, and invasive procedure rooms shall meet the following 
(1") Air supply shall be at or near the ceiling. Return or exhaust air registers shall be near the floor; 



121 
01 



Bottom of exhaust or return registers shall be no less than 3 inches (7.62 cm.) above the finished 
floor level; and 



Exhaust grilles for anesthesia evacuation and other special applications shall be permitted to be 
installed in the ceiling. 
(TO Isolation units shall meet the following: 
(1) Rooms for isolation of patients shall meet the ventilation requirements of Table _1 (See 10 NCAC 
03C .6225); 



121 
ill 



A separate anteroom used as an air lock to minimize the potential for airborne particulates from 
the patients' area reaching adjacent areas shall be provided; and 

Air supply shall be introduced at or near the ceiling, flowing past the patient, and exhausted or 
returned at the floor. 
£ll Smoke control/evacuation system(s) shall meet the following: 

(1) When an engineered smoke control/evacuation system is provided, the system shall incorporate a 
design of the air duct system(s) and controls to inhibit the migration of smoke from the fire zone 
to the required means of egress and refuge areas; 

(2) When an emergency manual control stop switch is provided to shut down supply, return, and 
exhaust fans, the switch shall be incorporated into the smoke control system in a manner that will 
not jeopardize the effectiveness or dependability of the smoke control/evacuation system; 

(3) Static pressure sensors, freeze-stats, or other operating controls shall not jeopardize the 



1848 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



effectiveness of the smoke control system during emergency operation; 

(4) Where smoke dampers are required to be installed as part of a passive smoke control system, 
smoke dampers shall be installed in ducts that are capable of communicating smoke between floors; 
and 

(5) Smoke dampers shall have a maximum air leakage of 10 cubic feet per minute per square foot of 
damper opening when tested at one inch water gauge of duct pressure. Smoke dampers shall be 
fail-safe to the emergency position. Dampers shall close upon activation of the fire alarm system 
unless a part of an engineered smoke control system. 

(m) Laboratories shall meet the following: 

(1) In new construction and renovation work, each hood used to process infectious or radioactive 
materials shall have a minimum face velocity of 150 feet per minute with static pressure operated 
dampers and audio-visual alarms to alert staff of ventilation system failure. Each hood shall also 
have filters with a 99.7 percent efficiency (based on the POP, dioctyl-phthalate test method) in the 
exhaust stream, and be designed and equipped to permit the safe removal, disposal, and 
replacement of contaminated filters; and 

(2) Each installation shall have an exhaust fan located at the discharge end of the duct system to 
maintain a negative pressure in the exhaust duct. 

(n) Where ethylene oxide is used, the following requirements shall be met: 

(1) Equipment utilizing ethylene oxide shall be installed in accordance with equipment manufacturer's 
installation instructions; and 

(2) An air flow sensing device shall be installed in the exhaust duct. The sensor shall activate a visible 
and audible signal to alert personnel of ventilation system failure. 

Statutory Authority G.S. 131E-79. 

.6226 PLUMBING AND OTHER PIPING SYSTEMS REQUIREMENTS 

(a) A toilet room shall be directly accessible from each patient room and from each central bathing area 
without going through the general corridor. One toilet room may serve two patient rooms but not more than 



eight beds. The lavatory may be omitted from the toilet room if one ]s provided in each patient room. 



(b) All plumbing systems shall be installed in such a manner as to completely prevent the possibility of cross 
connections between safe and unsafe supplies or back siphonage. 



(c) The following standards shall apply to plumbing fixtures: 

(1) Lavatories and sinks installed in patient care areas shall have the water spout mounted so that its 
discharge point is a maximum distance of 5 inches (12.7 cm.) above the rim of the fixture; 

(2) All fixtures used by medical and nursing staff and all lavatories used by patients and food handlers 
shall be trimmed with valves that can be operated without hands (single-lever devices may be used). 
Blade handles used for this purpose shall not exceed 4.5 inches (1 1.4 cm.) in length. Handles on 
scrub sinks and clinical sinks shall be at least 6 inches (15.2 cm.) long; and 

(3) Showers and tubs shall have non-slip walking surfaces. 

(d) The following standards shall apply to potable water su pply systems: 

(1) Vacuum breakers shall be installed on hose bibbs and supply nozzles used for connection of hoses 
or tubing; 

(2) Bedpan-flushing devices shall be provided in each inpatient toilet room; installation is optional in 
psychiatric and substance-abuse treatment units where patients are ambulatory; 

(3) Potable water storage vessels (hot and cold) not intended for constant use shall not be installed: and 

(4) All piping, except control-line tubing, shall be identified. All valves shall be tagged, and a valve 
schedule shall be provided to the facility owner for permanent record and reference. Where the 
functional program includes hemodialysis, continuously circulated filtered cold water shall be 
provided. 

(e) The following standards shall apply to hot water systems: 

(1) The water-heating system shall have sufficient supply capacity at the temperatures and amounts 
indicated in Table 3^ Water temperature is measured at the point of use or inlet to the equipment; 
and 

Table 3 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1849 



PROPOSED RULES 



Minimum Hot Water Capacity Requirements 





Use 


Clinical 


Dietary 


Laundry 


Gallons/Hour/Bed 


6,5 


4 


4^5 


Liters/Second/Bed 


.007 


.004 


.005 


Temperature „F 


116 


180 


180 


Temperature „C 


46.7 


82.2 


82.2 



(2) Hot-water distribution systems serving patient care areas shall be under constant recirculation 



provide continuous hot water at each hot water outlet. The temperature of hot water for showe 

and bathing shall be appropriate for comfortable use but shall not exceed 116°F (46.6°C). 

(f) The following standards shall apply to drainage systems: 

(1) Drain lines serving some types of automatic blood-cell counters shall be of carefully selects 



material that will eliminate the potential for undesirable chemical reactions or explosions betwe< 

sodium azide wastes and copper, lead, brass, and solder; 

(2) Drainage piping shall be installed to avoid installations in the ceiling directly over operating ai 

delivery rooms, nurseries, food preparation centers, food serving facilities, food storage area 



central services, electronic data processing areas, electrical closets, and other sensitive area 



141 

15] 
16} 



Where overhead drain piping in these areas is unavoidable, special provisions such as auxilia 

drain pans shall be installed to protect the space below from leakage; 

Floor drains shall not be installed in operating and delivery rooms, but may be installed 

cystoscopic operating rooms; 

Drain systems for autopsy tables shall be designed to avoid splatter or overflow onto floors or bac 

siphonage and for easy cleaning and trap flushing; 

Kitchen grease traps shall be located and arranged to permit easy access without the need to enti 

food preparation or storage areas; and 

Where plaster traps are used, provisions shall be made for routine access and cleaning. 



(g) The performance, maintenance, installation, and testing of medical gas systems, laboratory gas system 



and clinical vacuum systems shall comply with the requirements of the latest edition of National Fi 
Protection Association Standard 99 and Table 4 for medical gas station outlet requirements. When any pipii 



or supply of medical gases ]s installed, altered, or augmented, the altered zone shall be tested and certifi 



as required by National Fire Protection Association Standard 99. Testing shall be conducted by. the facilil 
and at least one other independent testing organization to ensure that the system is safe for patient use- 
Table 4 
Minimum Medical Gas Station Outlets and Vacuum Station Inlets 



Location 



Oxygen 



Vacuum 



Medical Ai 



Operating Room 
Delivery Rooms 
Cystoscopy Room 
Special Procedures Room 
Other anesthetizing Locations 



2/room 
2/room 
1/room 
1/room 
1/room 



3/room 
3/room 
3/room 
3/room 
3/room 



1/room 
1/room 



1/room 
1/room 



Recovery Room 



1/bed 



3/ bed 



1/bed 



1850 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:2 



PROPOSED RULES 



Intensive Care Unit 
Cardiac Intensive Care Unit 
Emergency Room 
Trauma Room 



2/bed 
2/bed 
I /bed 
2/bed 



3/bed 
2/bed 
1/bed 
3/bed 



1/bed 
1/bed 
1/bed 
1/bed 



Catheterization Lab 

Labor Room 

Nurseries 

Patient Room 

Exam & Treatment Rooms 



1/bed 
1/bed 
1/ bassinet 
1/bed 
1/bed 



2/bed 

1/bed 

1/bassinet 



1/bed 
1/bed 



1/bed 



Anesthesia Workroom 
Autopsy Room 



1/room 



1/room 
1/room 



1/room 



(h) The line pressure for the medical gases shall be set in the following order: 

(1) Oxygen, highest pressure; 

(2) Medical air, next to lowest pressure; and 

(3) Nitrous oxide, lowest pressure. 



Statutory Authority G.S. 131E-79. 

6227 ELECTRICAL REQUIREMENTS 

(a") All material and equipment, including con- 
ductors, controls, and signaling devices, shall be 
installed in compliance with a pplicable sections of 
North Carolina State Building Code, Volume VII, 
Electrical. A written record of performance tests 
on electrical systems and equipment shall show 
compliance with applicable codes and standards. 

(b) The main switchboard shall be located in an 
area separate from plumbing and mechanical 



equipment and shall be accessible to authorized 
persons only. The main switchboard shall be 



located in a dry, ventilated space free of corrosive 
or explosive fumes, gases, or any combustible 
material. 



(c) Panelboards serving normal lighting and 
appliance circuits shall be located on the same 
floor as the circuits they serve. Panelboards for 
emergency system critical branch and equipment 
system branch circuits shall be located on each 
floor that has service requirements. Only panels 
for emergency system life safety branch circuits 
may serve floors other than the floor that the panel 
is located on. 

(d) Lighting shall be provided as follows: 

(1) A pproaches to buildings and parking 
lots, and all occupied spaces within 
buildings shall have fixtures for light- 
ing; 



(2) Patient rooms shall have general light- 
ing and night lighting. A reading light 
shall be provided for each patient. At 
least one night light fixture in each 
patient room shall be controlled at the 
room entrance. All light controls in 
patient areas shall be quiet-operating. 
Lighting for special care bed areas shall 
permit staff observation of the patient 
but shall minimize glare; 

(3) Nursing unit corridors shall have gener- 
al illumination with provisions for 
reducing light levels at night; and 

(4) Consideration shall be given to control- 
ling lighting intensity to prevent harm 
to the patients' eyes (i.e., retina damage 
in premature infants and cataracts due 
to ultraviolet light). 

(e) Receptacles shall be provided as follows: 

(1) Each operating room and delivery room 
shall have at least eight 120 volt duplex 
receptacles; 

(2) In areas where mobile X-ray equipment 
is intended to be used, single recepta- 
cles marked for X-ray equipment only 
shall be installed; 

£3} Neonatal Level I nurseries shall have at 
least one 120 volt duplex receptacle for 
each bassinet connected to the normal 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1851 



PROPOSED RULES 



£41 



electrical service and at least one 120 
volt duplex receptacle located on each 
nursery wall connected to the critical 
branch of the emergency electrical 
system; 

Emergency department examination and 
treatment rooms shall have a minimum 
of two 120 volt duplex receptacles 
located convenient to the head of each 
bed. Trauma rooms shall have a mini- 



mum of thre^ 120 volt duplex recepta- 
cles convenient to the head of each bed; 

(5) 120 volt duplex receptacles for general 
use shall be installed 50 feet (15,2 m.) 
apart in all corridors and within 25 feet 
(7.6 m.) of corridor ends; and 

(6) Inhalation anesthetizing locations and 
other areas where patients are intended 
to have a direct electrical path to the 
heart muscle shall be equipped with an 
approved isolated power system as 
follows: 

(A) The line isolation monitor shall be 
visible to attending staff while caring 
for the patient; 

No more than two patients may be 
served by one isolated power system 
serving emergency power receptacles; 
Transformers shall not be located 



ID 
ID) 



over any patient bed location; and 
Branch circuit wiring for i solated 
power systems shall have a dielectric 
constant of less than 3.5. 
(f) Emergency electrical service shall be provid- 
ed as follows: 

(1) To provide electricity during an inter- 
ruption of normal electrical service, a 
generating set or sets located on the 
facility site capable of carrying the full 
emergency load shall be installed; 
Fuel shall be stored on the site in suffi- 



£2} 



131 



14} 



cient quantity to provide for not less 
than 24 hours of operation; 
Where the generator sets are in close 
proximity to the heating plant, the 
emergency generator fuel storage ca- 
pacity may be included in the standby 
fuel storage tank for the heating burners 
when the fuels are the same; 
All devices, switches, receptacles, etc., 
connected to the automatically started 
generator shall be distinctively identi- 
fied so that personnel can easily select 
which device is expected to operate 
during a failure of the normal source of 



power; and 

(5) As a minimum, the following area 
shall be connected to the essentia 
electrical system: 



{A} 



Task lighting connected to the critica 
branch of the emergency system t 
serve boiler rooms, main switchgea 
rooms, electrical closets, fire pum 
rooms, central fire alarm and contro 



m 



rooms, central telephone switchboar 

room; and 

Heating equipment and associate! 



controls to provide heating for patien 



care areas shall be connected to th 

equipment system . 

(g) A nurses' calling system shall be provided a 

follows: 

(1) Each patient room shall be served by a 



least one calling station for two-wa; 
voice communication. Each bed shal 
be provided with a call device. Tw 
call devices serving adjacent beds ma; 
be served by one calling station. Call 
shall activate a visible signal in th< 
corridor at the patient's door, in thj 
clean workroom, in the soiled work 



room, and at the nursing station of thj 
nursing unit. In multi-corridor nursins 



units, additional visible signals shall b( 



installed at corridor intersections. It 



rooms containing two or more callins 



stations, indicating lights shall be pro 
vided at each station. Nurses callin; 



systems at each calling station shall be 
equipped with an indicating light whicl 



remains lighted as long as the voire 

circuit is operating; 

£21 An emergency calling station shall bj 

provided at each patient-use toilet, bath 



sitz bath, and shower. This station 



shall be accessible to a patient lying oj 
the floor. Inclusion of an approved p ul 



cord will satisfy this standard. The 
emergency call system shall bj 
designed so that a signal activated at a 
patient's calling station will initiate a 
visible and audible signal distinct from 



the regular nurse calling system that 
can be turned off only at the patient 



121 



calling station. The signal shall activate 
an enumerator panel at the nurse 
station, and a visible signal in the 
corridor at the room: 
In areas such as special care where 
patients are under constant visual 



1852 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



surveillance, the nurses' call system 
may be limited to a bedside button or 
station that activates a signal readily 
seen at the control station; and 
(4) A staff emergency assistance system for 
staff to summon additional assistance 
shall be provided in each operating, 
delivery, recovery, emergency 
examination or treatment area, and in 
special care units, nurseries, special 
procedure rooms, stress-test areas, 
triage, out-patient surgery admission 
and discharge areas, and areas for 
mental patients, including seclusion and 
security rooms, anterooms and toilet 
rooms serving them, communal toilet 
and bathing facility rooms, therapy, 
exam, and treatment rooms. This 
system shall annunciate at the nurse 
station with back-up to another staffed 
area from which assistance can be 
summoned. 

Statutory Authority G.S. 131E-79. 

TITLE 12 - DEPARTMENT OF 
JUSTICE 

Notice is hereby given in accordance with G.S. 
150B-21.2 that the N. C. Alarm Systems Licensing 
Board intends to adopt rule cited as 12 NCAC 11 
.0123. 

1 he proposed effective date of this action is June 
1, 1995. 

lhe public hearing will be conducted at 2:00 
p.m. on March 8, 1995 at the State Bureau of 
Investigation Conference Room, 3320 Old Garner 
Road, Raleigh, N. C. 27626-0500. 

iVeasonfor Proposed Action: The Rule sets forth 
consumer disclosure requirements for those en- 
gaged in the alarm systems business. The initial 
draft of the rule was published in 9:15 NCR 1175. 
Substantial changes have been made to the rule 
and the Board has chosen to republish the rule and 
schedule another public hearing. 

Ksomment Procedures: Interested persons may 
present their views either orally or in writing at 
the hearing. The Record of Hearing will be open 



for receipt of written comments through March 8, 
1995. Written comments must be delivered to the 
Alarm Systems Licensing Board, 3320 Old Garner 
Road, Raleigh, N. C. 27626-0500. 

CHAPTER 11 - N.G ALARM 
SYSTEMS LICENSING BOARD 

SECTION .0100 - ORGANIZATION 
AND GENERAL PROVISIONS 

.0123 CONSUMER CONTRACT AND 
DISCLOSURE REQUIREMENTS 
FOR ALARM SERVICES 

(a) Every person, firm, association or corpora- 
tion licensed to engage in the alarm systems 
business in North Carolina who sells, installs, 
services, responds to or monitors electrical, elec- 
tronic or mechanical alarm systems shall execute 
with the consumer a written contract in all transac- 
tions that must consist of the following: 

(U A description of the sale(s) and/or 
service(s) in brief, simple terminology; 

(2) The company's name, address, tele- 
phone number, and North Carolina 
Alarm Systems License Number and the 
North Carolina Alarm Systems Licens- 
ing Board's address and telephone 
number. 

(b) Any person, firm, association or corporation 
licensed to engage in the alarm systems business in 
North Carolina by providing sales, installation, 
service, response,or monitoring to a consumer and 
who unilaterally terminates, causes to be terminat- 
ed or reasonably knows of the termination of the 
monitoring, response or service to that consumer, 
shall provide notification to that consumer by 
verified personal service or certified mail at least 
10 days prior to cessation of the service(s). This 
provision shall not a pply to consumer initiated 
action to terminate or upon consumer relocation. 

(c) Any person, firm, association or corporation 
licensed to engage in the alarm systems business in 
North Carolina by_ providing sales, installation, 
service, response, or monitoring to a consumer 
and who changes or causes to be changed the 
monitoring, response or service to that consumer, 
shall provide written notification to that consumer 
of the change, the effective date, and the name, 
address and telephone number of the new provider. 

Statutory Authority G.S. 74C-2(a); 74C-5. 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1853 



PROPOSED RULES 



TITLE 15A - DEPARTMENT OF 

ENVIRONMENT, HEALTH, AND 

NATURAL RESOURCES 

J\otice is hereby given in accordance with G.S. 
150B-21.2 that the N.C. Wildlife Resources Com- 
mission intends to amend rule cited as 15A NCAC 
IOC .0404. 

1 he proposed effective date of this action is July 
1, 1995. 

1 he public hearing will be conducted at 10:00 
a.m. on February 20, 1995 at the Archdale Build- 
ing, 3rd Floor, 512 N. Salisbury Street, Raleigh, 
NC 27604-1188. 

Ixeason for Proposed Action: To require that gill 
nets be attended in order to reduce game fish 
mortality. 

(comment Procedures: Interested persons may 
present their views either orally or in writing at 
the hearing. In addition, the record of hearing 
will be open for receipt of written comments from 
February 1, 1995 through March 4, 1995. Such 
written comments must be delivered or mailed to 
the N. C. Wildlife Resources Commission, 512 N. 
Salisbury Street, Raleigh, NC 27604-1188. 

CHAPTER 10 - WILDLIFE RESOURCES 
AND WATER SAFETY 

SUBCHAPTER IOC - INLAND FISHING 
REGULATIONS 

SECTION .0400 - NONGAME FISH 

.0404 SPECIAL DEVICE FISHING 

(a) Bow and Arrow. The use of bow [as de- 
fined in 15A NCAC 10B .0116(a)] and arrow as a 
licensed special device is authorized for taking 
nongame fishes at any time from all inland fishing 
waters other than impounded waters located on the 
Sandhills Game Land and designated public moun- 
tain trout waters. Unless specifically prohibited, 
bow and arrow may be used in joint fishing wa- 
ters. It is unlawful to take fish with crossbow and 
arrow in any inland fishing waters. 

(b) Nets. Manually operated nets, including 
seines and bow, cast, dip, gill, drift and fyke nets 
may be used under the special device fishing 



license. 

(1) No fixed gill net or other stationary net 
which may be authorized as a special 
fishing device may be more than 100 
yards in length, nor shall any such net 
be placed within 50 yards of any othei 
fixed net. Fixed nets must be set so that 
they run parallel to the nearest shore- 
line, except in the Neuse, Trent, North 
east Cape Fear, Cape Fear, and Black 
Rivers and their tributaries. No an- 
chored or fixed gill net or drift net shall 
be used unless such net is marked for 
the protection of boat operators. A net 
shall be deemed so marked when there 
is attached to it at each end two sepa 
rate yellow buoys which shall be of 
solid foam or other solid buoyant mate 
rial no less than five inches in its small- 
est dimensions. The owner shall al- 
ways be identified on a buoy on each 
end either by using engraved buoys or 
by attaching engraved metal or plastic 
tags to the buoys. Such identification 
shall include one of the following, 
owner's N.C. motor boat registration 
number, or owner's U.S. vessel docu 
mentation name, or owner's last name 
and initials. 

(2) It is unlawful to attach gill nets to any 
wire, rope, or similar device extended 
across any navigable watercourse. 

(3) All fixed or drift gill nets must be 
attended when fished in the designated 
inland waters of Bertie. Camden. 
Chowan. Currituck. Dare. Gates. 
Hertford. Martin. Pasquotank. 



Perquimans. Tyrrell and Washington 
counties. Attended as used in this 
Rule, requires that fishermen be within 



100 yards of all sets of nets at all times. 



(c) Traps. Baskets and traps, including automo- 
bile tires, may be used under the special device 
fishing license. Such devices when set and left 
unattended shall be affixed with a card or tag 
furnished by the license holder and upon which his 
name and address shall be legibly and indelibly 
inscribed. No fish trap may exceed 60 inches in 
length or 30 inches in depth or width. No lead 
nets, wing nets, or other device designed to guide 
or herd fish may be attached to the trap or used or 
set within 25 feet of the trap. 

(d) Spears. Manually operated gigs or 
under-water spear or harpoon guns may be used 
under the special fishing device license in the 



1854 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



PROPOSED RULES 



inland waters having a season for their use speci- 
fied in Rule .0407 of this Section. 

(e) Crab pots. Persons owning property adja- 
cent to the inland fishing waters of coastal rivers 
and their tributaries are permitted to set two crab 
pots to be attached to their property and not 
subject to special device license requirements. 

Statutory Authority G.S. 113-134; 113-272.2; 
113-276; 113-292. 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1855 



RRC OBJECTIONS 






1 he Rules Review Commission (RRC) objected to the following rules 


in accordance with G.S. 


150B-21.9(a). State agencies are required to respond to RRC as provided in 


G.S. 150B-21. 12(a) 




COMMERCE 






Banking Commission 






4 NCAC 3K .0201 - Application for Authorization/ /Reverse Mortgage Lender 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


4 NCAC 3K .0205 - Certificate of Authorization 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


4 NCAC 3K .0206 - Nontransferability of Certificate of Authorization 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


4 NCAC 3K . 0601 - Counseling 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 



CORRECTION 
Division of Prisons 

5 NCAC 2B .0111 - Good Time 

Agency Revised Rule 
5 NCAC 2B .0112 - Gain Time 

Agency Revised Rule 
5 NCAC 2B .0113 - Earned Time 

Agency Revised Rule 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Environmental Health 

15 A NCAC 18A .2801 - Definitions 

15 A NCAC 18A .2810 - Specifications for Kitchens, Based on Number/Children 

Environmental Management 

15A NCAC 2Q .0112 - Applications Requiring Professional Engineer Seal 
No Response from Agency 
Rule Returned to Agency 
Agency Filed Rule for Codification Over RRC Objection 

General Procedures for Public Health Programs 

15A NCAC 24A .0404 - Reimbursement for Services Not Covered by Medicaid 
RRC Approved Motion to Reconsider 
Rule Returned to Agency 
Agency Filed Rule for Codification Over RRC Objection 

Marine Fisheries 

ISA NCAC 31 .0017 - Fishery Resource Grant Program 



RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 



01/19/95 
01/19/95 
01/19/95 
01/19/95 
01/19/95 
01/19/95 



RRC Objection 01/19/95 
RRC Objection 01/19/95 



RRC Objection 11/17/94 

Obj. Cont'd 12/15/94 

Obj. Cont'd 01/19/95 

Eff. 02/01/95 



RRC Objection 12/15/94 

Obj. Cont'd 12/15/94 

Obj. Cont'd 01/19/95 

Eff. 02/01/95 



RRC Objection 01/19/95 



1856 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



RRC OBJECTIONS 






Agency Revised Rule 


Obj. Removed 


01/19/95 


15 A NCAC 30 .0304 - Consideration of Appeal Petitions 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


Wildlife Resources and Water Safety 






15 A NCAC 10B .0106 - Wildlife Taken for Depredations or Accidentally 


RRC Objection 


11/17/94 


Agency Revised Rule 


Obj. Cont'd 


11/17/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


15 A NCAC 10G .0206 - Authority of Boat Registration Agents 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


HUMAN RESOURCES 






Facility Services 






10 NCAC 3H .0221 - Administrative Penalty Determination Process 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


10 NCAC 3T.0102 - Definitions 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


10 NCAC 3T . 1109 - Resident Care Areas 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


Individual and Family Support 






10 NCAC 42C .3601 - Administrative Penalty Determination Process 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


Medical Assistance 






10 NCAC 26H .0211 - DRG Rate Setting Methodology 


RRC Objection 


01/19/95 


10 NCAC 26H .0212 - Exceptions to DRG Reimbursement 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


10 NCAC 26H .0216- Cost Reporting and Audits 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


10 NCAC 50B .0402 - Financial Responsibility and Deeming 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


INSURANCE 






Actuarial Services Division 






11 NCAC 16 .0705 - Claim Reserve Methodology and Actuarial Certification 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


Agent Services Division 






11 NCAC 6A .0801 - Definitions 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


11 NCAC 6A .0805 - Calculation oflCECs 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


11 NCAC 6A .0808 - Instructor Qualification 






Rule Withdrawn by Agency 




01/19/95 


11 NCAC 6A .0809 - Approval of Courses 






Rule Withdrawn by Agency 




01/19/95 


9:21 NORTH CAROLINA REGISTER February 1, 


1995 


1857 



RRC OBJECTIONS 



11 NCAC 6A .0811 - Sanctions for Noncompliance 
Rule Withdrawn by Agency 

LABOR 

Boiler and Pressure Vessel 



13 NCAC 13 .0202 

Agency Revised 
13 NCAC 13 .0204 

Agency Revised 
13 NCAC 13 .0205 

Agency Re\ised 
13 NCAC 13 .0211 

Agency Revised 
13 NCAC 13 .0212 

Agency Revised 
13 NCAC 13 .0213 

Agency Rexised 
13 NCAC 13 .0304 

Agency Revised 
13 NCAC 13 .0402 

Agency Revised 
13 NCAC 13 .0405 

Agency Revised 
13 NCAC 13 .0411 

Agency Revised 



- Inspector Qualification 
Rule 

- Conflict of Interest 
Rule 

- Owner-User Inspection Agency 
Rule 

- Certificate Inspections 
Rule 

- Preparation for Inspection 
Rule 

- Fees 
Rule 

- Appeals 
Rule 

- North Carolina Stamping and Registration 
Rule 

- Safety \alves 
Rule 

- Valves, Drains, and Bottom Blowoffs 
Rule 



Private Personnel Services 

13 NCAC 17 .0102 - Licensing Procedures 

Agency Revised Rule 
13 NCAC 17 .0105 - Fee Reimbursement 



01/19/9. 



RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 
RRC Objection 
Obj. Removed 



RRC Objection 
Obj. Removed 



12/15/9 
12/15/9 
12/15/9' 
12/15/9- 
1211519- 
12/15/9- 
12/15/9- 
12/15/9< 
12/15/9< 
1211519a 
12/15/9' 
1211519a 
12/15/9' 
12/15/9' 
12/15/9' 
12/15/9' 
12/15/94 
12/15/9' 
12/15/94 
12/15/94 



01/19/95 
01/19/95 



Rule Withdrawn by Agency 




01/19/95 


LICENSING BOARDS AND COMMISSIONS 






Commission for Auctioneers 






21 NCAC 4B .0501 - Application for Course Approval 






Rule Withdrawn by Agency 




12/15/94 


21 NCAC 4B .0502 - Requirements for Approval/ Minimum Standards 






Rule Withdrawn by Agency 




12/15/94 


Board of Dietetics/Nutrition 






21 NCAC 17 .0113 -Fees 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


21 NCAC 17 .0201 - Definitions 


RRC Objection 


01/19/95 


Agency Rexised Rule 


Obj. Removed 


01/19/95 


21 NCAC 17 .0202 - Requirement for Review 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


21 NCAC 17 .0203 - Review and Board Action 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


1858 NORTH CAROLINA REGISTER 


February 1, 1995 


9:21 



RRC OBJECTIONS 






Board of Examiners of Electrical Contractors 






21 NCAC 18B .0901 - Applicants Convicted of Crimes 


RRC Objection 


01/19/95 


Board of Opticians 






21 NCAC 40 .0314 - Apprenticeship and Internship Requirements; Registration 


RRC Objection 


11/17/94 


Agency Revised Rule 


Obj. Cont'd 


11/17/94 


No Response from Agency 


Obj. Cont'd 


12/15/94 


Agency Responded 


Obj. Cont'd 


01/19/95 


Board of Professional Engineers and Land Surveyors 






21 NCAC 56 . 0502 - Application Procedure: Individual 


RRC Objection 


11/17/94 


Rule Returned to Agency 


Obj. Cont'd 


12/15/94 


Agency Filed Rule for Codification Over RRC Objection 


Eff. 


01/01/95 


PUBLIC EDUCATION 






Elementary and Secondary Education 






16 NCAC 6E .0202 - Interscholastic Athletics 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


SECRETARY OF STATE 






Notary Public Division 






18 NCAC 7 .0103 - Notaries Public Deputy 


RRC Objection 


12/15/94 


Agency Repealed Rule 


Obj. Removed 


12/15/94 


18 NCAC 7 .0301 - Approved Course of Study 


RRC Objection 


12/15/94 


No Response from Agency 


Obj. Cont'd 


01/19/95 


18 NCAC 7 . 0302 - Instructors 


RRC Objection 


12/15/94 


No Response from Agency 


Obj. Cont'd 


01/19/95 


TRANSPORTATION 






Division of Highways 






19 A NCAC 2B .0603 - Driveway Permits for Special Commercial Property 


RRC Objection 


12/15/94 


Agency Revised Rule 


Obj. Removed 


12/15/94 


19 A NCAC 2D . 0825 - Confidentiality of Cost Estimates and Plan Holder Lists 


RRC Objection 


01/19/95 


Agency Revised Rule 


Obj. Removed 


01/19/95 


9:21 NORTH CAROLINA REGISTER February 1, 


1995 


1859 



CONTESTED CASE DECISIONS 



1 his Section contains the full text of some of the more significant Administrative Law Judge decisions 
along with an index to all recent contested cases decisions which are filed under North Carolina's 
Administrative Procedure Act. Copies of the decisions listed in the index and not published are available 
upon request for a minimal charge by contacting the Office of Administrative Hearings, (919) 733-2698. 



AGENCY 



ADMINISTRATION 

North CaroUna Council for Women 

Family Violence Prevention Services v. N.C. Council for Women 

ALCOHOLIC BEVERAGE CONTROL COMMISSION 

Jerry Lee McGowan v. Alcoholic Beverage Control Comm. 

Alcoholic Beverage Control Comm. v. Entertainment Group, Inc. 

Alcoholic Beverage Control Comm. v. Daehae Chang 

Rayvon Stewart v. Alcoholic Beverage Control Commission 

Alcoholic Beverage Control Comm. v. Branchland, Inc. 

Alcoholic Beverage Control Comm. v. Peggy Sutton Walters 

Russell Bernard Speller d/b/a Cat's Disco v. Alcoholic Bev Ctl Comm. 

Alcoholic Beverage Control Comm. v. Branchland, Inc. 

Edward Ogunjobi, Club PiccadilH v. Alcoholic Beverage Control Comm. 

Robert Kovalaslce, Nick Pikoulas, Joseph Marshburn, Evangelos Pikoulas, 

d/b/a Our Mom's BBQ v. Alcoholic Beverage Control Commission 
Christine George Williams v. Alcoholic Beverage Control Comm. 
Lynn Ann Garfagna v. Alcoholic Beverage Control Commission 
Alcoholic Beverage Control Comm. v. Raleigh Limits, Inc. 
Alcoholic Beverage Control Comm. v. COLAP Enterprises, Inc. 
Alcoholic Beverage Control Comm. v, Mitch's Tavern, Inc. 
Alcoholic Beverage Control Comm. v. Ms. Lucy Jarrell Powell 
Alcoholic Beverage Control Comm. v. Richard Wayne Barrow 
Alcoholic Beverage Control Comm. v. Subhashbai C. fttel 
Alcoholic Beverage Control Comm. v. Daphne Ann Harrell 
Mr. & Mrs. Josh Bullock Jr. v. Alcoholic Beverage Control Comm. 
Jerome Crawford v. Alcoholic Beverage Control Commission 
Lawrence Mungin v. Alcoholic Beverage Control Commission 
Willie Poole Jr. v. Alcoholic Beverage Control Commission 
Alonza Mitchell v. Alcoholic Beverage Control Commission 
Roy Dale Cagle v. Alcoholic Beverage Control Commission 
Christopher C. Gause, James A Jinwright v. Alcoholic Bev. Ctl. Comm. 
Rajaddin Abdelaziz v. Alcoholic Beverage Control Commission 
Alcoholic Beverage Control Comm. v. Sherrie Rena Quick 
Carol Hewitt v. Alcoholic Beverage Control Commission 
Alcoholic Bev. Ctrl. Comm. v. I^rtnership, T/A Price Downs Food Mart 
Alcoholic Beverage Control Comm. v. Sheila Charlesine Hildebrand 
Alcoholic Beverage Control Comm. v. James Earl Mullins, Sr. 

COMMERCE 



CASE 
NUMBER 



94 DOA 0242 



AIJ 



DATE OF 
DECISION 



West 



04/13/94 



93 ABC 0363 


Morrison 


08/23/94 


93 ABC 0719 


Gray 


03/02/94 


93 ABC 0775 


Morrison 


09/21/94 


93 ABC 0793 


Nesnow 


04/11/94 


93 ABC 0892 


Morgan 


06/03/94 


93 ABC 0906 


Mann 


03/18/94 


93 ABC 0937 


Morrison 


03/07/94 


93 ABC 0993 


Morgan 


06/03/94 


93 ABC 1024 


West 


03/03/94 


93 ABC 1029 


Gray 


03/04/94 


93 ABC 1057 


Bee Ion 


04/21/94 


93 ABC 1481 


Gray 


07/19/94 


93 ABC 1485 


Mann 


03/11/94 


94 ABC 0060 


Nesnow 


06/07/94 


94 ABC 0064 


Gray 


07/26/94 


94 ABC 0070 


Morgan 


06/06/94 


94 ABC 0079 


Gray 


10/14/94 


94 ABC 0083 


West 


11/01/94 


94 ABC 0115 


Nesnow 


07/18/94 


94 ABC 0124 


Morgan 


06/06/94 


94 ABC 0125 


Morgan 


06/06/94 


94 ABC 0149 


Chess 


08/08/94 


94 ABC 0232 


Chess 


09/02/94 


94 ABC 0257 


Morrison 


07/28/94 


94 ABC 0260 


West 


07/13/94 


94 ABC 0532 


Gray 


09/27/94 


94 ABC 0600 


Chess 


09/22/94 


94 ABC 0717 


Gray 


12/16/94 


94 ABC 0804 


Gray 


01/04/95 


94 ABC 0856 


West 


11/22/94 


94 ABC 0909 


Bee ton 


01/10/95 


94 ABC 0934 


West 


12/05/94 



PUBLISHED DECISION 
REGISTER CITATION 



9:11 NCR 870 



Savings Institutions Division 

James E. Byers, et al v. Savings Institutions 

CORRECTION 

Division of Prisons 

Gene Strader v. Department of Correction 



93 COM 1622 Chess 



94 DOC 0252 



03/01/94 



Morrison 03/21/94 



1860 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 






CASE 




DATE OF PUBLISHED DECISION 


AGENCY 


NUMBER 


ALJ 


DECISION REGISTER CITATION 


CRIME CONTROL AND PUBLIC SAFETY 








Joseph Guernsey & Intents, Robert Guernsey & Dolores Guernsey 


94 CPS 0413 


Gray 


07/11/94 


v. Pitt County Hospital Eastern Radiologists 








Crime Victims Compensation Commission 








Mae H. McMillan v. Crime Victims Compensation Commission 


92 CPS 1328 


Morgan 


08/11/94 


James Hugh Baynes v. Crime Victims Compensation Commission 


93 CPS 0801 


West 


03/28/94 9:2 NCR 114 


Ross T. Bond v. Victims Compensation Commission 


93 CPS 1104 


West 


04/21/94 


James A. Canady v. Crime Victims Compensation Commission 


93 CPS 1108 


Gray 


03/28/94 


Virginia Roof v. Department of Crime Control &. Public Safety 


93 CPS 1347 


Nesnow 


03/24/94 


Karen C. Tilghman v. Crime Victims Compensation Commission 


93 CPS 1608 


Reilly 


05/17/94 9:6 NCR 407 


Rosemary Taylor v. Crime Victims Compensation Commission 


93 CPS 1626 


Nesnow 


05/25/94 


Violet E. Kline v. Crime Victims Compensation Commission 


93 CPS 1670 


Morgan 


06/13/94 


James Benton v. Crime Victims Compensation Commission 


94 CPS 0034 


Chess 


06/14/94 


I^rcy Clark v. Crime Victims Compensation Commission 


94 CPS 0127 


Reilly 


04/19/94 


J. Richard Spencer v. Crime Victims Compensation Commission 


94 CPS 0157 


Chess 


06/14/94 


Albert H. Walker v. Crime Victims Compensation Commission 


94 CPS 0229 


Reilly 


08/11/94 


Barbara Henderson v. Crime Victims Compensation Commission 


94 CPS 0259 


Morrison 


04/07/94 


Shirley Handsome v. Crime Victims Compensation Commission 


94 CPS 0286 


Gray 


04/28/94 


Georgeann Young v. Crime Victims Compensation Commission 


94 CPS 0292 


Reilly 


04/18/94 


Lawrence L. Tyson v. Crime Victims Compensation Commission 


94 CPS 0368 


Gray 


04/26/94 


Ada Battle v. Crime Victims Compensation Commission 


94 CPS 0414 


Reilly 


08/23/94 


Lyman L. Chapman v. Crime Victims Compensation Commission 


94 CPS 0415 


Chess 


06/02/94 


Douglas and Virginia Wilson v. Crime Victims Compensation Comm. 


94 CPS 0417 


Reilly 


06/07/94 


Blanche J. Taylor v. William Hooks Jr., Crime Victims Comp. Comm. 


94 CPS 0464 


Mann 


10/28/94 


Michelle L. Wilcox v. Crime Victims Compensation Commission 


94 CPS 0467 


Reilly 


06/07/94 


Charlie E. McDonald v. Crime Victims Compensation Commission 


94 CPS 0468 


Gray 


09/02/94 9:13 NCR 1056 


Lillie Al ford /behalf /estate /Ve nise Alford v. Crime Victims Comp. Comm. 


94 CPS 0488 


West 


11/10/94 


Michael G. Low v. Crime Victims Compensation Commission 


94 CPS 0524 


Morrison 


06/13/94 


Torbit Smith v. Victims Compensation Commission 


94 CPS 0535 


Bee ton 


10/26/94 


Maureen P. Wilson v. Crime Victims Compensation Commission 


94 CPS 0567 


Gray 


09/23/94 


Kay Thompson Chambers v. Crime Victims Compensation Commission 


94 CPS 0581 


Morrison 


09/28/94 


James R. Gray v. Crime Victims Compensation Commission 


94 CPS 0603 


Reilly 


08/19/94 


Hazel Jarvis v. Victims Compensation Commission 


94 CPS 0664 


Chess 


07/29/94 


Pattie Hale v. Victims Compensation Fund 


94 CPS 0734 


West 


09/06/94 


Dana Harris v. Crime Victims Compensation Commission 


94 CPS 0832 


Nesnow 


09/26/94 


Dorian Walter St. J^trick Scott v. Victims Compensation Comm. 


94 CPS 0883 


Nesnow 


10/04/94 


Susan Cooley v. Crime Victims Compensation Commission 


94 CPS 1004 


Gray 


12/27/94 


In the Matter of the Claim of Claimant: Shirley Robinson Victim: 


94 CPS 1070 


Nesnow 


12/12/94 


Dandre J. Lamont Offender Charles Fernandez v. Crime Victims 








Compensation Comm. 








Mary E. Haskins v. Crime Victims Compensation Commission 


94 CPS 1406 


Gray 


03/17/94 


EMPLOYMENT SECURITY COMMISSION 








David Lee Bush v. Employment Security Commission 


91 ESC 0395 


Reilly 


08/18/94 


ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 








Bobby Stallings v. Environment, Health, and Natural Resources 


90 EHR 0612 


Morgan 


08/11/94 


James M. Lyles v. Brunswick County Office of Permits 


92 EHR 0333 


Chess 


09/22/94 


Erby Lamar Grainger v. Environment, Health, & Natural Resources 


93 EHR 0071 


Reilly 


11/22/94 


William P. Shaver, R. McKinnon Morrison HI, Till Ray, Dr. Wesley 


93 EHR 0452 


Morgan 


08/11/94 


C. Ray, Douglas W Furr, Catherine H. Furr & Caldwell Creek Farm, Inc 








v. EHNR-State of North Carolina 








Ron D. Graham, Suzanne C. Graham v. Robert Cobb, Mecklenburg Cry 


93 EHR 1017 


Bee ton 


05/31/94 


Robert, Stephanie & Joshua Campbell v. EHNR; Child. Spcl Hlth Svcs 


93 EHR 1019 


Bee ton 


12/28/94 9:20 NCR 1688 


Camel D. Pearson Jr. v. Craven Co. Division of Health & DEHNR 


93 EHR 1759 


Mann 


09/06/94 


Patricia D. Solomon v. Macon County Health Department 


93 EHR 1777 


West 


05/23/94 


Elbert L. Winslow v. EHNR/Guilford Cty Health Dept. & Guilford Cty 


94 EHR 0086 


Chess 


07/13/94 


Planning & Zoning Board 








Kathryn A. Whitley v. Macon County Health Department 


94 EHR 0088 


West 


07/13/94 


Brook Hollow Estates v. Environment, Health, & Natural Resources 


94 EHR 0093 


West 


06/03/94 


Laney Oil Company, Inc. v. Environment, Health, & Natural Resources 


94 EHR 0098 


Nesnow 


01/13/95 


Bobby Combs v. Public Water Supply Section 


94 EHR 0202 


West 


10/19/94 


9:21 NORTH CAROLINA REGISTER 


February 


1, 1995 1861 



CONTESTED CASE DECISIONS 



AGENCY 



Oceanfront Court, David C. Gagnon v. Environment, Health, & Nat. Res. 
Sam's Club #8219 v. Mecklenburg County Health Department 
Everhart & Associates., Inc. and Hettie Tolson Johnson v. Environment, 

Health, and Natural Resources and Zelig Robinson 
Richaid A. Jenkins v. NC Water Pollution Ctl. Sys. Op. Cert. Comm. 
Eugene Crawford & Nancy P. Crawford v. Macon County Health Dept. 
Joseph B. Leggett v. Environment, Health, &. Natural Resources 
Tri-Circuite, Inc. v. Environment, Health, & Natural Resources 
Thomas Taylor Fain v. Martin-Tyrrell-Wash. Dist. Health Dept., EHNR 
Marlen C. Robb, Jr. v. CAMA, Washington, NC EHNR 
Irene, Will, Eric Litaker v. Montgomery County Health Department 
James Loder v. New Hanover Inspection Svcs., Local CAMA Permit Off. 
National Food Market v. Environment, Health, and Natural Resources 

Coastal Management 

Roger Fuller v. EHNR, Div. of Coastal Mgmt & Environmental Mgmt 
Roger Fuller v. EHNR, Div. of Coastal Mgmt &. Environmental Mgmt 
John R. Hooper v. EHNR, Div./Coastal Mgmt &. Bird's Nest ftrtnership 
Gary E. Montalbine v. Division of Coastal Management 
F^ley-Midgett Partnership v. Coastal Resources Commission 

Craven County Health Department 

Cox Transport Equipment, Harvey A Cox v. County of Craven, EHNR 

Environmental Health 

Jane C. CMalley, Melvin L. Cartwright v. EHNR & District Hlth Dept 

Pasqu o tank - Ft rqu i mans- Camd e n - Ch owan 
Henry Lee Bulluck v. Nash County Health Department & EHNR 
Environment, Health, & Natural Res. v. Clark Harris & Jessie Lee Harris 
Richaid F. Ebersold v. Jackson County Health Department & EHNR 
Crab Shack Restaurant v. EHNR, Div. of Environmental Health 
Sidney S. Tate Jr. v. Dept. of Environment, Health, & Natural Resources 
George A Waugh, Shirley A. Waugh v. Carteret Cty Health & Env. Hlth 
Scotland Water Co., Laurin Lakes v. Environment, Health, & Nat. Res. 
H.A. Lentz v. Department of Environment, Health, &. Natural Resources 
Floyd Benn Williams v. Dept. of Environment, Health, &. Nat. Res. 
Robert Leon Snipes v. Environmental Health, Hillsborough NC 
Ralston Pound, Jr. & Deanie S. Pound v. Carteret Cty. Env. Health Dept. 

Environmental Management 

David Springer v. Dept. of Environment, Health, &. Natural Resources 
Petroleum Installation Equipment Co., Inc. v. Env., Health & Nat. Res. 
Howell's Child Care Center, Inc. v. EHNR, Div of Environmental Mgmt. 
Spring Valley Meats. Inc. v. Environment, Health, & Natural Resources 
Jack Griffin v. Dept. of Environment, Health, and Natural Resources 
Wooten Oil Company v. EHNR, Div of Environmental Management 
John G. Owens &. J.B.S. Mechanical Svcs, Inc. v. EHNR, Env. Mgmt. 
General Electric Co., Inc. v. EHNR, Env. Mgmt. Comm. & City/Mebane 

Land Resources 

Wallace B. Clayton, Dr. Marshall Redding v. Div. of Land Resources 
Town of Kernersville (LQS 93-053) v. Environment, Health, & Nat. Res. 
Royce Perry, Paul Perry v. Dept. of Environment, Health. &. Natural Res. 

Marine Fisheries 



CASE 




DATE OF 


NUMBER 


ALJ 


DECISION 


94 EHR 0210 


Chess 


06/21/94 


94 EHR 0329 


Nesnow 


06/15/94 


94 EHR 0392 


Reilly 


10/18/94 


94 EHR 0424 


West 


10/11/94 


94 EHR 0500 


Gray 


06/10/94 


94 EHR 0560 


West 


09/21/94 


94 EHR 0601 


Morrison 


06/30/94 


94 EHR 0736 


West 


11/22/94 


94 EHR 0767 


West 


11/22/94 


94 EHR 0776 


Gray 


09/06/94 


94 EHR 0821 


Chess 


11/21/94 


94 EHR 0998 


Reilly 


12/19/94 



89 EHR 1378^ 


Gray 


04/07/94 


90 EHR 0017* 


Gray 


04/07/94 


90 EHR 0455 


Morgan 


08/11/94 


93 EHR 1792 


Nesnow 


03/21/94 


94 EHR 0315 


Gray 


06/01/94 



94 EHR 0487 



West 



11/01/94 



91 EHR 0838 


Bee ton 


04/06/94 


93 EHR 0348 


Morgan 


07/22/94 


93 EHR 0924 


Bee ton 


03/03/94 


93 EHR 1391 


Chess 


06/24/94 


93 EHR 1609 


Gray 


12/27/94 


94 EHR 0005 


Reilly 


05/24/94 


94 EHR 0128 


Chess 


07/13/94 


94 EHR 0200 


Nesnow 


04/27/94 


94 EHR 0235 


Nesnow 


07/19/94 


94 EHR 0333 


Reilly 


05/18/94 


94 EHR 0529 


Morrison 


01/04/95 


94 EHR 1003 


Reilly 


12/07/94 



92 EHR 1797 


Morgan 


05/19/94 


93 EHR 0531 


Chess 


03/21/94 


93 EHR 0955 


West 


11/02/94 


93 EHR 0974 


West 


11/03/94 


93 EHR 1030 


Bee ton 


03/21/94 


94 EHR 0001 


West 


09/30/94 


94 EHR 0024 


Mann 


09/07/94 


94 EHR 1031 


Reilly 


11/30/94 



93 EHR 1407 


Morgan 


08/09/94 


93 EHR 1781 


Chess 


06/29/94 


94 EHR 0525 


Gray 


07/01/94 



PUBLISHED DECISION 
REGISTER CITATION 



9:7 NCR 
9:15 NCR 



496 
1231 



9:19 NCR 1595 



9:8 NCR 581 



Robert I. Swinson, Virginia S. Swinson v. EHNR, Div/Marine Fisheries 
Larry J. Batson v. Division of Marine Fisheries 
David W. Oglesby v. Division of Marine Fisheries 
David E. Oglesby v. Division of Marine Fisheries 



93 EHR 0394 


Gray 


04/11/94 






93 EHR 0857 


Morgan 


07/22/94 






93 EHR 0930* 


West 


07/25/94 


9:10 NCR 


758 


93 EHR 0931* 


West 


07/25/94 


9:10 NCR 


758 



Consolidated Cases. 



1862 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 






CASE 




DATE OF PUBLISHED DECISION 


AGENCY 


NUMBER 


ALJ 


DECISION REGISTER CITATION 


James Goodman v. EHNR, Division of Marine Fisheries 


94 EHR 0035 


Nesnow 


07/18/94 9:9 NCR 660 


Billy Ervin Burton v. Division of Marine Fisheries 


94 EHR 0504 


Nesnow 


09/01/94 


Maternal and Child Health 








W1C Section 








Anthony Awueah v. EHNR, Div. Maternal & Child Health, WIC Section 


94 EHR 0718 


Chess 


09/23/94 


Orange Finer Food v. Environment, Health, and Natural Resources 


94 EHR 0965 


Reilly 


12/19/94 


Salah Helu v. Environment, Health, and Natural Resources 


94 EHR 0976 


Reilly 


12/20/94 


Solid Waste Management 








Roger Sessoms v. EHNR/ Asbestos Hazard Management Branch 


93 EHR 0951 


Gray 


03/28/94 


Bertie Citizens Action Coalition, Inc.; Willaid J. Oliver, Reginald Early, 


93 EHR 1045 


Morrison 


04/06/94 9:3 NCR 214 


Herbert Jenkins, Jr. , Lind wood Earl Tripp, Willie Warren Tripp, Mary 








Alice Cherry, and Kathy Burden v. EHNR, Solid Waste Management 








Division, and East Carolina Environmental, Inc., Addington Environmental, 






Inc., et al. 








Bobby Benton v. EHNR & Division of Solid Waste 


94 EHR 0442 


Gray 


08/22/94 


HUMAN RESOURCES 








Jerome Triplin v. Department of Human Resources 


93 DHR 0108 


Reilly 


08/19/94 


Helen J. Walls, Walls Young World v. Department of Human Resources 


93 DHR 0965 


Morgan 


08/11/94 


Brenda C. Robinson v. Department of Human Resources 


94 DHR 0365 


West 


06/01/94 


Betty King v. Department of Human Resources 


94 DHR 0439 


Chess 


12/15/94 


Betty Rhodes v. Department of Human Resources 


94 DHR 0501 


Morrison 


06/02/94 


Mr. & Mrs. Richaid Bullen v. Department of Human Resources 


94 DHR 0811 


Becton 


11/14/94 


Distribution Child Support 








Mona L. Stanback v. DHR, Div/Social Svcs, Child Support Enf. Section 


93 DCS 0969 


Morgan 


08/02/94 


Jachell D. Parker v. Department of Human Resources 


93 DCS 0371 


Morgan 


07/14/94 


Earlecn G. Tinsley v. Department of Human Resources 


94 DCS 0651 


Nesnow 


09/15/94 


Division of Child Development 








Judith Fridley v. Div. of Child Development/ Abuse/Neglect Unit 


93 DHR 0973 


Morrison 


03/08/94 


DHR, Division of Child Development v. Joyce Gale 


93 DHR 1344 


Gray 


04/28/94 


Laurcen Holt, ID#26-0-00037 v. DHR, Div. of Child Development 


93 DHR 1549 


Becton 


07/13/94 


Gloria C. Haith v. Department of Human Resources 


93 DHR 1707 


Nesnow 


03/22/94 


Gloria C. Haith v. Daycare Consultant , 


93 DHR 1787 


Nesnow 


03/14/94 


Charles E. Smith v. Department of Human Resources 


93 DHR 1797 


Nesnow 


03/21/94 


Scotfs Loving Day Care & Nursery, Mrs. Willie L. Scott v. DHR 


94 DHR 0106 


Nesnow 


06/29/94 


Belinda K. Mitchell v. Human Resources, Div. of Child Development 


94 DHR 0119 


Reilly 


06/30/94 


Living Woid Day Care, Jonathan Lankford v. Dept. of Human Resources 


94 DHR 0168 


Nesnow 


03/23/94 


David G. Whined, Pres., Toddles Academy, Inc. v. Div of Child Dev. 


94 DHR 0453 


Mann 


09/23/94 


Miriam C. Kircher v. Human Resources, Div. of Child Development 


94 DHR 0615 


Morrison 


11/17/94 


Mary T. Hill v. Human Resources, Division of Child Development 


94 DHR 0944 


Chess 


11/16/94 


Facility Services 








Laura Harvey Williams v. DHR, Division of Facility Services 


93 DHR 0391 


Morgan 


08/11/94 


Presbyterian-Orthopaedic Hospital v. Department of Human Resources 


93 DHR 0805 


Reilly 


03/11/94 


Judy Hoben Wallace v. Department of Human Resources 


93 DHR 0935 


Gray 


05/23/94 


Lowell Stafford v. Department of Human Resources 


93 DHR 1381 


Gray 


04/15/94 


Willie J. McCombs v. Human Resources, Div. of Facility Services 


94 DHR 0430 


Gray 


09/29/94 


Mr. & Mrs. AJvin Wilson v. DHR, Division of Facility Services 


94 DHR 0559 


Chess 


08/25/94 


Steve Alan Russell v. DHR, Div. of Facility Svcs, Emergency Med. Svcs 


94 DHR 0830 


Gray 


11/28/94 


Bettie Graham v. Youth and Family Services, Charlotte, N.C. 


94 DHR 1527 


Gray 


01/04/95 


Certificate of Need Section 








Charles E. Hunter, Jr., M.D. & Coastal Perfusion Svcs, Inc. v. 


93 DHR 0746 


Morgan 


04/11/94 


Department of Human Resources, and Wilmington Perfusion 








Corp. and Howard F. Marks, Jr., M.D. 








Cape Fear Memorial Hospital v. Department of Human Resources 


93 DHR 1552 


Reilly 


08/15/94 


9:21 NORTH CAROLINA REGISTER 


February 


1, 1995 1863 



CONTESTED CASE DECISIONS 



AGENCY 



Angel Community Hospital, Inc. V. DHR, Div. of Facility Svcs., Cert./ 

Need Section, and Brittha'en, Inc., d/b/a Brittha'en of Franklin 
The Carrolton of Fayetteville, Inc. v. Department of Human Resources 

and 
Highland House of Fayetteville, Inc. & Richard R. Allen Sr. v. DHR 
The Carrolton of Fayetteville, Inc. v. Department of Human Resources 

and 
Highland House of Fayetteville, Inc. & Richard R. Allen Sr. V. DHR 
ABC Home Health Services, Inc. v. Human Resources, Div. of Facility 

Sen-ices, Certificate of Need Section v. Mecklenburg Home Health, Inc 

d/b/a Home Health Professionals of Guilford 
Professional Nursing Services, Inc. and Betty Wallace v. Certificate of 

Need Section, Div. of Facility Services, Human Resources 
and 

Duplin Home Care & Hospice, Inc.; Hometown Hospice, Inc.; Craven County 

Health Dept. Home Health-Hospice Agency; Hospice of Pamlico County; 

Inc.; Hospice of Carteret County; and Comprehensive Home Health Care I, Inc. 



Division of Medical Assistance 

J.R., by and through her agent & Personal Rep., Hank Neal v. DHR 
N.R. by & through her agt & personal rep E.C.J, v. DHR, Medical Assis. 
David Yott v. Department of Human Resources 

Sampson County Memorial Hospital v. DHR, Div of Medical Assistance 
Division of Medical Assistance v. Catawba Cty Dept. of Social Services 
Lu Ann Leidy, MD/Dorothea Dix Hosp. Child & Youth v. Medical Assis. 

Division of Social Services 

Evelyn Moore v. Department of Human Resources 

Nathaniel Harrell, Annie Harrell v. Department of Social Services 

Betty Snipes v. Person County Department of Social Services 

Child Support Enforcement Section 

Alfred Bennett v. Department of Human Resources 
Shelton Staples v. Department of Human Resources 
Helen Lee Harvell Jones v. Department of Human Resources 
Dalton Felton Sr. v. Department of Human Resources 
Colby S. Hughes v. Department of Human Resources 
Gary Eugene Honeycutt v. Department of Human Resources 
Vicki C. Conn v. Department of Human Resources 
John R. Lossiah v. Department of Human Resources 
Melvin L. Miller Sr. v. Department of Human Resources 
Robert L. Hicks v. Department of Human Resources 
Thomas Sadler v. Department of Human Resources 
Nancy Richardson v. Department of Human Resources 
Frederick C. Burdick Jr. v. Department of Human Resources 
Darryl D. Leedy v. Department of Human Resources 
David M. Fogleman Jr. v. Department of Human Resources 
William Heckstall v. Department of Human Resources 
Luther Hatcher v. Department of Human Resources 
Bryan Jeffrey Cole v. Department of Human Resources 
Anthony E. Bullard v. Department of Human Resources 
Donald E. Height v. Department of Human Resources 
Dexter L. Chambers v. Department of Human Resources 
Ronald E. Johnson v. Department of Human Resources 
Roger Moore v. Department of Human Resources 
Alvin Lee Martin v. Department of Human Resources 
James J. Malloy v. Department of Human Resources 
Robert Young v. Department of Human Resources 
Henry M. Dillard v. Department of Human Resources 
Vernon Byrd v. Department of Human Resources 
Sherman E. Ames v. Department of Human Resources 
Antonio Townsend v. Department of Human Resources 
Keith M. Gray v. Department of Human Resources 
Troy E. Pinkney v. Department of Human Resources 
Anthony A. Macon v. Department of Human Resources 



CASE 




DATE OF 


PUBLISHED DECISION 


NUMBER 


AU 


DECISION 


REGISTER CITATION 


94 DHR 0146 


West 


10/21/94 




94 DHR 0197*> 


Morgan 


08/11/94 




94 DHR 0198* 5 


Morgan 


08/11/94 




94 DHR 0254 


Morrison 


11/17/94 




94 DHR 0609 


West 


11/21/94 





93 DHR 0528 


Gray 


04/27/94 


93 DHR 0538 


Chess 


07/01/94 


93 DHR 1113 


Gray 


04/05/94 


93 DHR 1760 


West 


09/07/94 


93 DHR 1778 


West 


03/04/94 


94 DHR 0448 


Chess 


06/21/94 



94 DHR 0293 


Reilly 


04/15/94 


94 DHR 0440 


Gray 


06/27/94 


94 DHR 1061 


Gray 


12/16/94 



90CSE 1146 


Morgan 


08/11/94 


91 CSE 0660 


Morgan 


08/11/94 


91 CSE 1183 


Morgan 


08/11/94 


92 CSE 0532 


Morgan 


07/13/94 


92 CSE 1199 


Morgan 


08/10/94 


92 CSE 1207 


Morgan 


08/10/94 


92 CSE 1268 


Morgan 


08/10/94 


92 CSE 1345 


Mann 


10/13/94 


92 CSE 1372 


Morgan 


08/10/94 


92 CSE 1591 


Morgan 


08/10/94 


92 CSE 1739 


Bee ton 


10/18/94 


93 CSE 0180 


Chess 


11/22/94 


93 CSE 0227 


Mann 


11/09/94 


93 CSE 0591 


Morgan 


08/11/94 


93 CSE 1074 


Mann 


10/10/94 


93 CSE 1077 


Reilly 


03/14/94 


93 CSE 1082 


Mann 


05/24/94 


93 CSE 1091 


Bee ton 


03/30/94 


93 CSE 1094 


Nesnow 


06/13/94 


93 CSE 1110 


Morgan 


08/11/94 


93 CSE 1124 


West 


03/28/94 


93 CSE 1 125 


Bee ton 


03/30/94 


93 CSE 1127 


Bee ton 


04/14/94 


93 CSE 1128 


Nesnow 


04/04/94 


93 CSE 1 132 


Gray 


10/03/94 


93 CSE 1133 


Reilly 


04/18/94 


93 CSE 1135 


Nesnow 


06/13/94 


93 CSE 1136 


Beeton 


08/22/94 


93 CSE 1137 


Chess 


11/09/94 


93 CSE 1139 


Beeton 


03/30/94 


93 CSE 1140 


Nesnow 


06/28/94 


93 CSE 1148 


Mann 


03/29/94 


93 CSE 1149 


Gray 


04/26/94 



1864 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 



AGENCY 



Walter Lee Corbetl v. Department of Human Resources 

Joseph E. Kemstine v. Department of Human Resources 

Alvin M. Davis v. Department of Human Resources 

Thomas M. Bird well III v. Department of Human Resources 

Joe Louis Mayo v. Department of Human Resources 

Bobby Lewis Smith v. Department of Human Resources 

Lawrence D. Dean v. Department of Human Resources 

Louis C. Cade v. Department of Human Resources 

Richard J. Swarm v. Department of Human Resources 

Nash Andrew Newsome v. Department of Human Resources 

James E. Watson v. Department of Human Resources 

Robert Lee Barrett v. Department of Human Resources 

Anthony Raynor Sr. v. Department of Human Resources 

Betty A. Williams, Fred E. Jones v. Department of Human Resources 

Quinton Brickhouse v. Department of Human Resources 

Jeff A. Taylor v. Department of Human Resources 

Eric G. Sykes v. Department of Human Resources 

John Hagins v. Department of Human Resources 

Terrence D. Timmons v. Department of Human Resources 

Howard Vernon Adams v. Department of Human Resources 

Ray A. Johnstone v. Department of Human Resources 

Morris Ray Bethel v. Department of Human Resources 

William James Freeman v. Department of Human Resources 

Willie C. Hollis v. Department of Human Resources 

Edward Boggan v. Department of Human Resources 

Raymond Junior Cagle v. Department of Human Resources 

Ernest N. Pruitt Jr. v. Department of Human Resources 

Michael P. McCay v. Department of Human Resources 

Robert Matthew Rossi v. Department of Human Resources 

Bemad ett Cook v. Department of Human Resources 

Rawan Weigel v. Department of Human Resources 

Lem Person v. Department of Human Resources 

Bobby Lee McCulletB Jr. v. Department of Human Resources 

Randall R. Rhodes v. Department of Human Resources 

Glen Nelson Washington v. Department of Human Resources 

Michael V. Dockery v. Department of Human Resources 

Robert Corley Jr. v. Department of Human Resources 

Floyd E. Bailey v. Department of Human Resources 

Dennis W. Nolan v. Department of Human Resources 

Robert Calvin Connor v. Department of Human Resources 

James D. Williams v. Department of Human Resources 

Mahalon Eugene White v. Department of Human Resources 

Marty Franzen v. Department of Human Resources 

Vaughn D. Pearsall v. Department of Human Resources 

Gerald L. Murrell v. Department of Human Resources 

Larry D. Dawson v. Department of Human Resources 

McDaniel Teeter Jr. v. Department of Human Resources 

King D. Graham v. Department of Human Resources 

Brian C. Carelock v. Department of Human Resources 

Bradford C. Lewis v. Department of Human Resources 

Derek Watson v. Department of Human Resources 

Luther Borden v. Department of Human Resources 

Walter B. Lester v. Department of Human Resources 

Wilbert E. Anderson v. Department of Human Resources 

David H. Johnson v. Department of Human Resources 

William Earl Arrington v. Department of Human Resources 

William K. Whisenant v. Department of Human Resources 

Curtis C. Osborne v. Department of Human Resources 

Stanley J. Forsack v. Department of Human Resources 

Larry Cornelius Smith v. Department of Human Resources 

Robert C. Lee Jr. v. Department of Human Resources 

Sidney Ray Tuggle Jr. v. Department of Human Resources 

Michael A. Amos v. Department of Human Resources 

Reginald Eugene Hill v. Department of Human Resources 

Jimmy C. Harvell v. Department of Human Resources 

John Edward Tannehill v. Department of Human Resources 

Benjamin McCormick v. Department of Human Resources 

Steven Connet v. Department of Human Resources 



CASE 




DATE OF PUBLISHED DECISION 


NUMBER 


ALJ 


DECISION REGISTER CITATION 


93 CSE 1150 


Reilly 


03/30/94 


93 CSE 1151 


Morgan 


07/15/94 


93 CSE 1152 


Morgan 


08/04/94 


93 CSE 1 155 


Morgan 


08/02/94 


93 CSE 1161 


West 


04/19/94 


93 CSE 1 162 


Nesnow 


06/16/94 


93 CSE 1 165 


Gray 


10/27/94 


93 CSE 1166 


Morrison 


06/16/94 


93 CSE 1167 


Reilly 


06/17/94 


93 CSE 1170 


Mann 


03/17/94 


93 CSE 1171 


Gray 


04/26/94 


93 CSE 1172 


Morrison 


04/20/94 


93 CSE 1173 


Morrison 


10/27/94 


93 CSE 1178 


Nesnow 


04/20/94 


93 CSE 1179 


Gray 


01/05/95 


93 CSE 1180 


Morgan 


07/15/94 


93 CSE 1181 


Bee Ion 


04/20/94 


93 CSE 1182 


Mann 


11/14/94 


93 CSE 1183 


Becton 


10/11/94 


93 CSE 1184 


Chess 


12/27/94 


93 CSE 1186 


Morrison 


10/03/94 


93 CSE 1188 


West 


07/11/94 


93 CSE 1190 


Mann 


01/17/95 


93 CSE 1191 


Becton 


05/09/94 


93 CSE 1 192 


Chess 


09/01/94 


93 CSE 1 194 


Morrison 


10/03/94 


93 CSE 1 197 


Nesnow 


06/28/94 


93 CSE 1198 


Morgan 


08/02/94 


93 CSE 1199 


Becton 


08/22/94 


93 CSE 1202 


Gray 


04/27/94 


93 CSE 1212 


Gray 


08/26/94 


93 CSE 1214 


Morrison 


06/16/94 


93 CSE 1215 


Reilly 


06/17/94 


93 CSE 1219 


Nesnow 


06/16/94 


93 CSE 1221 


Morgan 


08/02/94 


93 CSE 1222 


Morgan 


07/15/94 


93 CSE 1225 


Chess 


10/05/94 


93 CSE 1227 


Mann 


07/07/94 


93 CSE 1254 


Morrison 


04/27/94 


93 CSE 1258 


West 


04/19/94 


93 CSE 1259 


West 


04/19/94 


93 CSE 1261 


Nesnow 


08/22/94 


93 CSE 1264 


Morgan 


07/15/94 


93 CSE 1267 


Becton 


04/20/94 


93 CSE 1271 


Gray 


08/26/94 


93 CSE 1273 


Morrison 


07/07/94 


93 CSE 1274 


Morrison 


06/30/94 


93 CSE 1275 


Becton 


05/18/94 


93 CSE 1276 


Mann 


10/13/94 


93 CSE 1278 


Mann 


10/13/94 


93 CSE 1283 


Reilly 


06/30/94 


93 CSE 1284 


West 


06/23/94 


93 CSE 1287 


Nesnow 


06/28/94 


93 CSE 1288 


Nesnow 


10/12/94 


93 CSE 1289 


Mann 


10/14/94 


93 CSE 1290 


Mann 


10/14/94 


93 CSE 1291 


Becton 


08/22/94 


93 CSE 1299 


Gray 


09/19/94 


93 CSE 1301 


Morrison 


08/23/94 


93 CSE 1302 


Morrison 


06/30/94 


93 CSE 1303 


Reilly 


06/30/94 


93 CSE 1307 


West 


04/25/94 


93 CSE 1308 


West 


07/15/94 


93 CSE 1309 


West 


10/06/94 


93 CSE 1310 


Nesnow 


10/27/94 


93 CSE 1312 


Nesnow 


10/03/94 


93 CSE 1313 


Morgan 


08/02/94 


93 CSE 1315 


Mann 


10/14/94 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1865 



CONTESTED CASE DECISIONS 



AGENCY 



Gregory N. Winley v. Department of Human Resources 
Ronald Brown v. Department of Human Resources 
David L. Hill v. Department of Human Resources 
Ronald Fred Metzger v. Department of Human Resources 
James L. Phillips v. Department of Human Resources 
John D. Bryant v. Department of Human Resources 
George Aaron Collins v. Department of Human Resources 
Ricky Glenn Mabe v. Department of Human Resources 
Samuel L. Dodd v. Department of Human Resources 
James W. Smith v. Department of Human Resources 
William A. Sellers v. Department of Human Resources 
Jerry Mclver v. Department of Human Resources 
Johnny B. Little v. Department of Human Resources 
Kenneth W. Cooper v. Department of Human Resources 
Nathan D. Winston v. Department of Human Resources 
Bobby Charles Coleman v. Department of Human Resources 
Anthony Curry v. Department of Human Resources 
Charles W. Norwood Jr. v. Department of Human Resources 
David L. Terry v. Department of Human Resources 
Audwin Lindsay v. Department of Human Resources 
Steven A. Elmquist v. Department of Human Resources 
Kelvin Dean Jackson v. Department of Human Resources 
Jerry R. Gibson v. Department of Human Resources 
Melvin Lewis Griffin v. Department of Human Resources 
Dennis E. Fountain Jr. v. Department of Human Resources 
Mark E. Rogers v. Department of Human Resources 
Daniel J. McDowell v. Department of Human Resources 
Edna VonCannon v. Department of Human Resources 
Darron J. Roberts v. Department of Human Resources 
Ephrom Sparkman Jr. v. Department of Human Resources 
Alton W. Ivey v. Department of Human Resources 
Terry James Carothers v. Department of Human Resources 
Terrance Freeman v. Department of Human Resources 
Thomas A. Ayers v. Department of Human Resources 
Daniel Thomas Hefele v. Department of Human Resources 
Gilbert J. Gutierrez v. Department of Human Resources 
Alton D. Johnson v. Department of Human Resources 
Darryl C. Thompson v. Department of Human Resources 
Jeffery E. Holley v. Department of Human Resources 
Chester Sanders v. Department of Human Resources 
Rodney Guyton v. Department of Human Resources 
Nelson Bennett v. Department of Human Resources 
Donald W. Clark v. Department of Human Resources 
William E. David Jr. v. Department of Human Resources 
Arthur Lee Carter v. Department of Human Resources 
Frank Reiff v. Department of Human Resources 
Milburn Ray Burton v. Department of Human Resources 
John J. Gabriel v. Department of Human Resources 
Robert Hayes v. Department of Human Resources 
Donald Ray Copeland v. Department of Human Resources 
Clark Anthony Bryant v. Department of Human Resources 
Timothy D. Evans v. Department of Human Resources 
Billy Edward Smith v. Department of Human Resources 
Allen D. Terrell v. Department of Human Resources 
Ray C. Moses v. Department of Human Resources 
Mickey Bridgett v. Department of Human Resources 
Steven W. Tallent v. Department of Human Resources 
Stephen L. Brown v. Department of Human Resources 
David Beduhn v. Department of Human Resources 
Bart Ransom v. Department of Human Resources 
William H. Simpson Sr. v. Department of Human Resources 
Clarence J. GatHng Jr. v. Department of Human Resources 
James D. McClure Jr. v. Department of Human Resources 
Timothy E. Stotlar v. Department of Human Resources 
Christopher Ivan Smith v. Department of Human Resources 
Douglas L. Cherrix v. Department of Human Resources 
Billy L. Sneed v. Department of Human Resources 
Dwayne Lamont Thompson v. Department of Human Resources 



CASE 




DATE OF 


NUMBKR 


ALJ 


DECISION 


93 CSE 1316 


Bee ton 


06/14/94 


93 CSE 1318 


Bee ton 


06/29/94 


93 CSE 1320 


Chess 


11/08/94 


93 CSE 1323 


Mann 


09/26/94 


93 CSE 1326 


Reilly 


06/17/94 


93 CSE 1327 


Reilly 


10/27/94 


93 CSE 1331 


West 


04/25/94 


93 CSE 1356 


Mann 


09/26/94 


93 CSE 1357 


Gray 


03/31/94 


93 CSE 1358 


Gray 


08/26/94 


93 CSE 1359 


Morrison 


04/20/94 


93 CSE 1362 


Reilly 


06/30/94 


93 CSE 1363 


West 


06/23/94 


93 CSE 1364 


West 


04/27/94 


93 CSE 1365 


Nesnow 


07/07/94 


93 CSE 1368 


Morgan 


08/02/94 


93 CSE 1371 


Chess 


08/18/94 


93 CSE 1385 


West 


06/13/94 


93 CSE 1386 


Mann 


05/18/94 


93 CSE 1390 


Morrison 


07/15/94 


93 CSE 1392 


Reilly 


04/29/94 


93 CSE 1394 


West 


06/13/94 


93 CSE 1411 


Nesnow 


08/24/94 


93 CSE 1412 


Morgan 


08/02/94 


93 CSE 1414 


Chess 


05/13/94 


93 CSE 1415 


Mann 


05/03/94 


93 CSE 1416 


Gray 


09/19/94 


93 CSE 1417 


Morrison 


06/14/94 


93 CSE 1419 


West 


08/23/94 


93 CSE 1422 


Morgan 


08/04/94 


93 CSE 1426 


Mann 


11/18/94 


93 CSE 1428 


Gray 


10/26/94 


93 CSE 1430 


Gray 


12/14/94 


93 CSE 1431 


Morrison 


06/30/94 


93 CSE 1432 


Morrison 


04/28/94 


93 CSE 1433 


Morrison 


05/13/94 


93 CSE 1434 


Reilly 


04/29/94 


93 CSE 1435 


Reilly 


06/30/94 


93 CSE 1436 


Reilly 


08/23/94 


93 CSE 1437 


West 


04/19/94 


93 CSE 1439 


West 


04/21/94 


93 CSE 1440 


Nesnow 


08/31/94 


93 CSE 1441 


Nesnow 


05/13/94 


93 CSE 1442 


Nesnow 


05/02/94 


93 CSE 1445 


Morgan 


08/10/94 


93 CSE 1448 


Bee ton 


08/22/94 


93 CSE 1449 


Chess 


11/29/94 


93 CSE 1452 


Chess 


05/16/94 


93 CSE 1453 


Mann 


07/07/94 


93 CSE 1454 


Mann 


10/10/94 


93 CSE 1455 


Gray 


06/30/94 


93 CSE 1460 


Reilly 


04/28/94 


93 CSE 1461 


West 


04/19/94 


93 CSE 1463 


Nesnow 


05/02/94 


93 CSE 1464 


Nesnow 


04/28/94 


93 CSE 1468 


Bee ton 


05/24/94 


93 CSE 1469 


Chess 


01/05/95 


93 CSE 1470 


Chess 


09/27/94 


93 CSE 1494 


Gray 


08/30/94 


93 CSE 1495 


Morrison 


04/29/94 


93 CSE 1497 


West 


04/19/94 


93 CSE 1499 


Morgan 


08/02/94 


93 CSE 1500 


Bee ton 


05/13/94 


93 CSE 1504 


Mann 


11/18/94 


93 CSE 1510 


Gray 


07/07/94 


93 CSE 1512 


Gray 


05/13/94 


93 CSE 1514 


Gray 


12/14/94 


93 CSE 1515 


Morrison 


04/21/94 



PUBLISHED DECISIOr. 
REGISTER CITATION 



1866 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 






CASE 




DATE OF PUBLISHED DECISION 


AGENCY 


NUMBER 


ALJ 


DECISION REGISTER CITATION 


Michael Edwin Smith v. Department of Human Resources 


93 CSE 1517 


Morrison 


08/26/94 


Horace Lee Bass v. Department of Human Resources 


93 CSE 1520 


Morrison 


05/13/94 


Michael Wilder v. Department of Human Resources 


93 CSE 1521 


Rcilly 


04/28/94 


William Howard Wright v. Department of Human Resources 


93 CSE 1522 


Reilly 


08/26/94 


James A. Cephas v. Department of Human Resources 


93 CSE 1523 


Reilly 


05/13/94 


Edward E. Furr v. Department of Human Resources 


93 CSE 1524 


Reilly 


06/17/94 


James Hunsaker v. Department of Human Resources 


93 CSE 1526 


Chess 


11/08/94 


James W. Ragsdale v. Department of Human Resources 


93 CSE 1528 


Reilly 


10/12/94 


Marie E. Campbell v. Department of Human Resources 


93 CSE 1537 


Nesnow 


05/19/94 


Vernon Lamont Weaver v. Department of Human Resources 


93 CSE 1538 


Nesnow 


09/23/94 


Jesse B. McAfee v. Department of Human Resources 


93 CSE 1539 


Nesnow 


09/26/94 


William Ellis v. Department of Human Resources 


93 CSE 1540 


Morgan 


08/02/94 


Henry A. Harriel Jr. v. Department of Human Resources 


93 CSE 1541 


Morgan 


08/04/94 


John H. Fortner Jr. v. Department of Human Resources 


93 CSE 1542 


Morgan 


08/02/94 


Mike Johnson v. Department of Human Resources 


93 CSE 1544 


Morgan 


08/04/94 


Carl E. Crump v. Department of Human Resources 


93 CSE 1545 


Bee ton 


09/23/94 


Herman F. Jacobs Jr. v. Department of Human Resources 


93 CSE 1557 


Chess 


09/27/94 


Barriet Easterling v. Department of Human Resources 


93 CSE 1560 


Mann 


05/18/94 


Dorsey L. Johnson v. Department of Human Resources 


93 CSE 1565 


Gray 


09/19/94 


Wade A. Burgess v. Department of Human Resources 


93 CSE 1568 


Morrison 


04/28/94 


Billy Dale Beaney v. Department of Human Resources 


93 CSE 1569 


Morrison 


05/13/94 


Gregory Harrell v. Department of Human Resources 


93 CSE 1570 


Morrison 


08/26/94 


James E. Wiggins Sr. v. Department of Human Resources 


93 CSE 1571 


Morrison 


05/13/94 


Tony A. Draughon v. Department of Human Resources 


93 CSE 1572 


Reilly 


07/07/94 


Gregory L. Rimmer v. Department of Human Resources 


93 CSE 1573 


Reilly 


09/23/94 


Ruben Jonathan Bostillo v. Department of Human Resources 


93 CSE 1574 


Reilly 


09/01/94 


Timothy J. Jones v. Department of Human Resources 


93 CSE 1576 


West 


04/19/94 


Randall E. Hunter v. Department of Human Resources 


93 CSE 1579 


West 


04/19/94 


Cyrus R. Luallen v. Department of Human Resources 


93 CSE 1583 


Nesnow 


06/16/94 


Willie Hawkins v. Department of Human Resources 


93 CSE 1585 


Morgan 


08/02/94 


B.A. Sellen v. Department of Human Resources 


93 CSE 1586 


Morgan 


08/02/94 


John R Vadas v. Department of Human Resources 


93 CSE 1589 


Bee ton 


11/08/94 


Gary T. Hudson v. Department of Human Resources 


93 CSE 1590 


Beeton 


09/23/94 


Alton E. Simpson Jr. v. Department of Human Resources 


93 CSE 1591 


Bee ton 


04/20/94 


Johnny T. Usher v. Department of Human Resources 


93 CSE 1592 


Chess 


05/19/94 


Tim H. Maxwell v. Department of Human Resources 


93 CSE 1594 


Chess 


06/30/94 


Charles Darrell Matthews v. Department of Human Resources 


93 CSE 1596 


West 


06/13/94 


John William Vance Jr. v. Department of Human Resources 


93 CSE 1597 


Beeton 


05/13/94 


Bobby R. Sandeis v. Department of Human Resources 


93 CSE 1598 


Nesnow 


07/25/94 


Michael S. Rhynes v. Department of Human Resources 


93 CSE 1599 


Nesnow 


06/30/94 


Gerry Bernard Whitfield v. Department of Human Resources 


93 CSE 1601 


Gray 


10/14/94 


Denise L. Smith v. Department of Human Resources 


93 CSE 1603 


Chess 


08/18/94 


Brian Gilmore v. Department of Human Resources 


93 CSE 1615 


Chess 


05/13/94 


Jesse Jeremy Bullock v. Department of Human Resources 


93 CSE 1632 


Morrison 


06/14/94 


Jeffrey Alston v. Department of Human Resources 


93 CSE 1634 


Morrison 


09/28/94 


Ronald E. Loweke v. Department of Human Resources 


93 CSE 1635 


Reilly 


06/17/94 


Robert D. I^rker v. Department of Human Resources 


93 CSE 1637 


Rerlly 


06/29/94 


Charles F. McKirahan Jr. v. Department of Human Resources 


93 CSE 1640 


West 


06/14/94 


Bennie E. Hicks v. Department of Human Resources 


93 CSE 1641 


Nesnow 


07/25/94 


Herbert Council v. Department of Human Resources 


93 CSE 1643 


Nesnow 


07/25/94 


Richard Rachel v. Department of Human Resources 


93 CSE 1644 


Morgan 


08/02/94 


Alan V. Teubert v. Department of Human Resources 


93 CSE 1645 


Morgan 


08/10/94 


Henry L. Ward Jr. v. Department of Human Resources 


93 CSE 1646 


Morgan 


08/02/94 


June V. Pettus v. Department of Human Resources 


93 CSE 1647 


Beeton 


10/31/94 


Benjamin J. Stroud v. Department of Human Resources 


93 CSE 1648 


Beeton 


05/19/94 


Charles Leonard Fletcher v. Department of Human Resources 


93 CSE 1649 


Beeton 


07/20/94 


Tony A. Miles v. Department of Human Resources 


93 CSE 1654 


Mann 


05/24/94 


Dwayne L. Allen v. Department of Human Resources 


93 CSE 1655 


Mann 


05/17/94 


Earl Newkirk Jr. v. Department of Human Resources 


93 CSE 1680 


Morrisoa 


08/26/94 


Reginald Rorie v. Department of Human Resources 


93 CSE 1683 


Gray 


10/14/94 


James Edwaid Penley v. Department of Human Resources 


93 CSE 1714 


Mann 


09/26/94 


Joe C. Dean v. Department of Human Resources 


93 CSE 1715 


Gray 


05/23/94 


Vernon Bullock v. Department of Human Resources 


93 CSE 1743 


Nesnow 


07/07/94 


Nathaniel L. Hayes v. Department of Human Resources 


93 CSE 1749 


Nesnow 


11/09/94 


Jessie Liles v. Department of Human Resources 


93 CSE 1757 


Morgan 


08/02/94 


Raymond Scott Eaton v. Department of Human Resources 


93 CSE 1761 


Beeton 


06/29/94 


Karen M. Stogner v. Department of Human Resources 


93 CSE 1785 


Chess 


11/08/94 


Nelson Fowler Jr. v. Department of Human Resources 


94 CSE 0039 


Mann 


10/10/94 


9:21 NORTH CAROLINA REGISTER 


February 


1, 1995 1867 



CONTESTED CASE DECISIONS 



AGENCY 



Royston D. Blandford ED V. Department of Human Resources 
Kenneth B. Taylor v. Department of Human Resources 
Jeffrey S. Anderson V. Department of Human Resources 
Ronald Erwin Williams v. Department of Human Resources 
Michael L. Franks v. Department of Human Resources 
Donnie W. Craghead v. Department of Human Resources 
Billy D. Gibson v. Department of Human Resources 
Ronald Garrett v. Department of Human Resources 
Ervin C. Harvey v. Department of Human Resources 
Wanda Jean Lee Daniels v. Department of Human Resources 
Charles E. Colston V. Department of Human Resources 
Daron Wayne Smith v. Department of Human Resources 
Maurice Franks v. Department of Human Resources 
John D. Melton v. Department of Human Resources 
Michael Lynn Jones v. Department of Human Resources 
Dennis Kearney v. Department of Human Resources 
Grayson Kelly Jones v. Department of Human Resources 
Larry Hayes v. Department of Human Resources 
Richard Eugene Dunn v. Department of Human Resources 
Warren F. Welch v. Department of Human Resources 
Donas Lynn McDowell v. Department of Human Resources 
Timothy R. Abraham v. Department of Human Resources 
Haywood C. Davis v. Department of Human Resources 
Fred Thompson Jr. v. Department of Human Resources 
Donell Howard v. Department of Human Resources 
Lee Johnson Tillman v. Department of Human Resources 
Haywood C. Davis v. Department of Human Resources 
Ernest F. Andrews v. Department of Human Resources 
Russell Pearson v. Department of Human Resources 
Richard D. Rhodes v. Department of Human Resources 
Jasper L. Smallwood v. Department of Human Resources 
Edgar K. Dutch, Sr. V, Department of Human Resources 
Larry Eugene Harbaugh V. Department of Human Resources 
Jerry McGlone v. Department of Human Resources 
Amos Sherman v. Department of Human Resources 
Donnie R. McKee v. Department of Human Resources 
Roland Reeves v. Department of Human Resources 
Givens Jackson v. Department of Human Resources 
James Sisk v. Department of Human Resources 
Raynard C. Terry v. Department of Human Resources 
Reginald W. Taylor v. Department of Human Resources 
Edward B. Slamey v. Department of Human Resources 
Danie L. Baker v. Department of Human Resources 
Lam G. Guthrie v. Department of Human Resources 
Timothy Russom v. Department of Human Resources 
Lois M. Geibel v. Department of Human Resources 



CASE 




DATE OF PUBLISHED DECISION 


NUMBER 


ALJ 


DECISION REGISTER CITATION 


94 CSE 0095 


West 


04/19/94 


94 CSE 0113 


Bee ion 


10/11/94 


94 CSE 0114 


Chess 


11/04/94 


94 CSE 0141 


Bee ton 


09/23/94 


94 CSE 0142 


Chess 


08/16/94 


94 CSE 0163 


Mann 


09/26/94 


94 CSE 0166 


Mann 


09/26/94 


94 CSE 0227 


Reilly 


08/22/94 


94 CSE 0247 


Bee ton 


08/22/94 


94 CSE 0266 


Morgan 


08/02/94 


94 CSE 0280 


Reilly 


08/30/94 


94 CSE 0300 


Gray- 


06/27/94 


94 CSE 0310 


West 


10/27/94 


94 CSE 0324 


Nesnow 


07/25/94 


94 CSE 0402 


Morgan 


08/02/94 


94 CSE 0411 


Bee ton 


12/13/94 


94 CSE 0433 


West 


09/15/94 


94 CSE 0456 


Nesnow 


08/22/94 


94 CSE 0494 


West 


07/29/94 


94 CSE 0541 


Mann 


11/09/94 


94 CSE 0580 


Mann 


01/17/95 


94 CSE 0595 


Reilly 


10/12/94 


94 CSE 0596*" 


Mann 


01/17/95 


94 CSE 0639 


Morrison 


08/31/94 


94 CSE 0672 


Reilly 


10/27/94 


94 CSE 0906 


West 


12/08/94 


94 CSE 0930*'° 


Mann 


01/17/95 


94 CSE 1079 


Chess 


12/29/94 


94 CSE 1104 


Morrison 


01/06/95 


94 CSE 1107 


Nesnow 


01/09/95 


94 CSE 1110 


Gray 


01/06/95 


94 CSE 1 129 


Gray 


01/06/95 


94 CSE 1223 


Morrison 


01/06/95 


94 CSE 1226 


Reilly 


01/06/95 


94 CSE 1227 


West 


01/10/95 


94 CSE 1265 


Nesnow 


01/09/95 


94 CSE 1268 


Nesnow 


01/09/95 


94 CSE 1282 


Chess 


01/05/95 


94 CSE 1375 


Morrison 


01/06/95 


94 CSE 1411 


Gray 


01/06/95 


94 CSE 1418 


Morrison 


01/06/95 


94 CSE 1448 


West 


01/10/95 


94 CSE 1453 


West 


01/10/95 


94 CSE 1540 


Reilly 


01/06/95 


94 CSE 1575 


West 


01/10/95 


94 CSE 1581 


Reilly 


01/06/95 



JUSTICE 



Alarm Systems Licensing Board 



Alarm Systems Licensing Board v. George P. Baker 
I^triek R Sassman v. Alarm Systems Licensing Board 
Christopher Ffcte v. Alarm Systems Licensing Board 
J^ul J. Allen v. Alarm Systems Licensing Board 



93 DOJ 0457 


Nesnow 


03/10/94 


94 DOJ 0709 


Chess 


09/12/94 


94 DOJ 0710 


Chess 


09/12/94 


94 DOJ 0964 


West 


10/31/94 



Private Protective Services Board 



Rex Allen Jefferies v. Private Protective Services Board 
Lam' C. Hopkins v. Private Protective Services Board 
Gregory K. Brooks V. Private Protective Services Board 
Stephen M. Rose v. Private Protective Services Board 
Lemuel Lee Clark Jr. V. Private Protective Services Board 
Dexter R. Usher v. Private Protective Services Board 
Frankie L. McKoy v. Private Protective Services Board 
John F Carmichael v. Private Protective Services Board 
Michael L. Bonner v. Private Protective Services Board 
Edward A. Maguire v. Private Protective Services Board 



93 DOJ 0647 


Rally 


08/01/94 


93 DOJ 1618 


Morrison 


03/07/94 


94 DOJ 0008 


Nesnow 


06/28/94 


94 DOJ 0359 


Nesnow 


05/19/94 


94 DOJ 0360 


Nesnow 


05/19/94 


94 DOJ 0648 


Reilly 


08/15/94 


94 DOJ 0706 


Chess 


09/09/94 


94 DOJ 0707 


West 


12/01/94 


94 DOJ 0794 


Morrison 


09/14/94 


94 DOJ 0795 


West 


12/09/94 



1868 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 



AGENCY 



CASE 
NUMBER 



94 DOJ 0796 



93 DOL 1747 

94 DOL 0956 



93 BMS 0532 



fohnny R. Dollar v. Private Protective Services Board 

Training and Standards Division 

}urtiss Lance Poteat v. Criminal Justice Ed. & Training Stds. Comm. 
Villie David Moore v. Criminal Justice Ed. & Training Stds. Comm. 
jlenn Travis Stout v. Criminal Justice Ed. & Training Stds. Comm. 
iteven W. Wray v. Sheriffs' Education & Training Standaids Comm. 
. Stevan North v. Sheriffs' Education & Training Standards Comm. 
Sregory Blake Manning v. Criminal Justice Ed. & Training Stds. Comm. 
lussell Pinkelton Jr. v. Sheriffs' Education & Training Stds. Comm. 
Villiam Franklin Sheetz v. Sheriffs' Education & Training Stds. Comm. 
ames M. Buie v. Criminal Justice Ed. & Training Stds. Comm. 
lurns E. Anderson v. Criminal Justice Ed. & Training Stds. Comm. 
kelson Falcon v. Sheriffs' Education & Training Stds. Comm. 

ABOR 

en Harmon v. Labor, Elevator and Amusement Device Division 
lonald D. Rumple v. Dept. of Labor, Wage & Hour Division 

lORTUARY SCIENCE 

lortuary Science v. Perry J. Brown, & Brown's Funeral Directors 
UBLIC EDUCATION 

Christopher Murch as Guardian Ad Litem for Angela D. Murch, a Minor 

v. Barbara Richardson, Admin. Except. Child. Prog.; Craven Cty School 

Sys.; Bradford L. Sneeden, Superintendent 
^ancy Watson v. Board of Education 
anet L. Wilcox v. Carteret County Boaid of Education 
Vnnice Granville, Phillip J. Granville v. Onslow County Bd. of Education 
lilt Sherman & Rose Marie Sherman v. Pitt County Boaid of Education 
lary Ann Sciullo & Frank Sciullo on behalf of their minor child, 

Samuel W Sciullo v. State Boaid of Education 
Vayne Hogwood v. Department of Public Instruction 
Jorman Charles Creange v. State Bd. of Ed., Dept. of Public Instruction 
^harlotte-Mecklenbutg Boaid of Education v. Lemuel and Patricial Gray, 

as Parents of Tanya and Daniel Gray 

flATE HEALTH BENEFITS OFFICE 

inda C. Campbell v. Teacheis & St Emp Major Medical Plan 
Imothy L. Coggins v. Teachers' & St Emp Comp Major Med Plan 
iandra Tatum v. Teacheis & State Employees Comp Major Medical Plan 
'H.B. v. Teacheis & State Employees Comp Major Medical Plan 

iTATE PERSONNEL 

rlichael L. K. Benson v. Office of State Personnel 

Agricultural and Technical State University 

-inda D. Williams v. Agricultural and Technical State University 
uanita D. Murphy v. Agricultural and Technical State University 
"nomas M. Simpson v. Agricultural and Technical State University 
■eggy L. Cantrell v. A&T State University 
*ricellaM. Curtis v. A&T State University Curriculum & Instruction 



department of Agriculture 

)onald H. Crawford v. Department of Agricultuie 

KC School of the Arts 

lick McCullough v. Search Comm School/Dance, NC School of the Arts 94 OSP 051 1 



93 OSP 1690 



94 OSP 0108 



ALJ 



DATE OF 
DECISION 



PUBLISHED DECISION 
REGISTER CITATION 



Morrison 08/24/94 



93 DOJ 0231 


Chess 


03/28/94 






93 DOJ 1071 


Nesnow 


04/11/94 


9:3 NCR 


21S 


93 DOJ 1409 


Gray 


03/03/94 






93 DOJ 1803 


Chess 


06/29/94 






94 DOJ 0040 


Chess 


06/16/94 






94 DOJ 0048 


Gray 


03/29/94 






94 DOJ 0118 


Gray 


08/10/94 






94 DOJ 0196 


Chess 


06/16/94 






94 DOJ 0401 


Nesnow 


08/26/94 






94 DOJ 0574 


Bee ton 


10/04/94 


9:15 NCR 


1234 


94 DOJ 0611 


Mann 


08/12/94 







Collier 
Reilly 



Chess 



12/27/94 
11/01/94 



03/28/94 



93 EDC0161 


Mann 


11/28/94 






93 EDC 0234 


Chess 


02/28/94 


9:2 NCR 


108 


93 EDC 0451 


Mann 


02/21/94 






93 EDC 0742 


Mann 


08/01/94 


9:11 NCR 


863 


93 EDC 1617 


West 


11/29/94 






94 EDC 0044 


Gray 


07/22/94 






94 EDC 0653 


West 


10/20/94 


9:16 NCR 


1326 


94 EDC 0737 


Morrison 


11/04/94 






94 EDC 1629 


Mann 


01/17/95 







93 INS 0410 


Bee ton 


04/22/94 






93 INS 0929 


Morrison 


03/04/94 






94 INS 0028 


Gray 


10/25/94 


9:16 NCR 


1331 


94 INS 0345 


Gray 


08/23/94 


9:12 NCR 


945 



Nesnow 



08/23/94 



93 OSP 0089 


Chess 


03/23/94 


93 OSP 0708 


Morrison 


03/16/94 


93 OSP 1393 


Gray 


03/24/94 


93 OSP 1694 


Reilly 


01/06/95 


94 OSP 0748 


Gray 


08/17/94 



Reilly 



West 



05/23/94 



10/14/94 



9:21 NCR 1875 



121 



NORTH CAROLINA REGISTER 



February 1, 1995 



1869 



CONTESTED CASE DECISIONS 



AGENCY 



CASE 
NUMBER 



ALJ 



DATE OF 
DECISION 



PUBLISHED DECISION 
REGISTER CITATION 



Butner Adolescent Treatment Center 

Alvin Lamonte Breeden v. Butner Adolescent Treatment Center 

Catawba County 

Sandra J. Cunningham v. Catawba County 

North Carolina Central University 

Dianna Blackley v. North Carolina Central University 
Ha-rilyah Ha-She'B v. NCCU 



94 OSP 0899 



93 OSP 1097 



89 OSP 0494 
93 OSP 0875 



Chapel Hill & Carrboro City School 

Brenda J. Parker v. Stella Nickereon, Chapel Hill & Carrboro City School 94 OSP 0568 

Cherry Hospital 



Charles F. Fields v. Cherry Hospital 

Gail Marie Rodgcrs Lincoln v. Cherry Hospital, Goldsboro, NC 27530 

Department of Commerce 

Ruth Daniel-ferry v. Department of Commerce 

Department of Correction 

Leland K. Williams v. Department of Correction 

Elroy Lewis v. North Central Area - Dept of Correction, Robert Lewis 

Steven R. Kellison v. Department of Correction 

Bert Esworthy v. Department of Correction 

James J. Lewis v. Department of Correction 

Merron Burrus v. Department of Correction 

Lewis Alsbrook v. Department of Correction, Morrison Youth Institution 

Junius C. F^ge v. Dept. of Correction, Secy. Franklin Freeman 

Grady Butler; Jr. v. Correction, Div./Prisons, Sampson Cty Ctl Laundry 

Richard Hopkins v. Department of Correction 

Alfred B. Hunt v. Department of Correction 

Charles Home v. Equal Emp. Opportunity Officer & Dept. of Correction 

Adrian E. Graham v. Intensive Probation/ftrole 

E. Wayne Irvin, D.D.S. v. Div. of Prisons, Department of Correction 

Thomas W C res well, Lisa K. Bradley v. Department of Correction 

Thomas W. Creswell, Lisa K. Bradley v. Department of Correction 

Barry Lee Clark v. Department of Correction 

Clyde M. Walker v. Department of Correction, Div. of Prisons 

Marietta A. Stancil v. Department of Correction 

Edward E. Hodge v. Department of Correction 

Phyllis K. Cameron v. Department of Correction 

Brenda Yvonne Ewell v. Department of Correction 

Debra D. McKoy v. Department of Correction 

Eastern Correctional Institution 

Roy A. Keel & Zebedee Taylor v. Eastern Correctional Institution 
Roy A. Keel & Zebedee Taylor v. Eastern Correctional Institution 

Guilford Correctional Center 
Ann R. Williams v. Guilford Correctional Center #4440 

McDowell Correctional Center 
Michael Junior Logan v. Kenneth L. Setzer, McDowell Com Ctr. 

Polk Youth Institution 
Joseph Mark Lewanowicz v. Department of Correction, JA>lk Youth Inst. 



94 OSP 0498 
94 OSP 0578 



93 OSP 0725 



Nesnow 



Reilly 



Nesnow 
Bee ton 



West 



Morrison 

West 



Chess 



94OSP0160* 4 
94 OSP 0256** 



94 OSP 0428 



94 OSP 0546 



94 OSP 0926 



Nesnow 
Nesnow 



West 



Gray 



Nesnow 



10/12/94 



04/29/94 



09/14/94 
04/13/94 



10/06/94 



06/15/94 
10/07/94 



03/04/94 



91 OSP 1287 


Chess 


02/22/94 


92 OSP 1770 


Bee ton 


05/24/94 


93 OSP 0283 


Chess 


06/15/94 


93 OSP 0711 


Chess 


04/21/94 


93 OSP 1121 


West 


08/31/94 


93 OSP 1145 


West 


09/30/94 


93 OSP 1739 


West 


07/20/94 


93 OSP 1794 


Mann 


07/08/94 


93 OSP 1804 


West 


11/30/94 


94 OSP 0041 


Chess 


06/16/94 


94 OSP 0243 


Reilly 


04/20/94 


94 OSP 0244 


Nesnow 


06/16/94 


94 OSP 0261 


Morrison 


04/26/94 


94 OSP 0334 


Chess 


10/03/94 


94 OSP 0407** 


Chess 


09/28/94 


94 OSP 0408** 


Chess 


09/28/94 


94 OSP 0437 


Chess 


09/12/94 


94 OSP 0476 


West 


12/30/94 


94 OSP 0652 


West 


11/22/94 


94 OSP 0829 


Nesnow 


09/15/94 


94 OSP 0896 


Nesnow 


10/27/94 


94 OSP 0959 


Gray 


12/12/94 


94 OSP 0960 


Gray 


12/12/94 



07/20/94 
07/20/94 



06/22/94 



09/01/94 



11/07/94 



9:4 NCR 292 



9:3 NCR 211 



9:1 NCR 63 



9:6 NCR 395 



1870 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 








CASE 




DATE OF 


PUBLISHED DECISION 


AGENCY 


NUMBER 


ALJ 


DECISION 


REGISTER CITATION 


Cosmetic Art Examiners 










Mary Quaintance v. N.C. State Board of Cosmetic Art Examines 


94 OSP 0372 


Chess 


06/14/94 




Department of Crime Control and Public Safety 










Don R. Massenburg v. Department of Crime Control & Public Safety 


90 OSP 0239 


Chess 


04/28/94 




Fred L. Kearney v. Department of Crime Control & Public Safety 


91 OSP 0401 


West 


03/18/94 




J.D. Booth v. Department of Crime Control & Public Safety 


92 OSP 0953 


Morrison 


10/18/94 




Sylvia Nance v. Department of Crime Control & Public Safety 


92 OSP 1463 


Reilly 


03/21/94 




Jerry Lewis v. Dept. of Crime Control & Public Safety, Highway Patrol 


93 OSP 1058 


West 


12/30/94 




Anthony R. Butler v. Highway Patrol 


93 OSP 1079 


West 


08/30/94 




Ruth P. Belcher v. Crime Control & Public Safety, State Highway Patrol 


94 OSP 0190 


Gray 


09/06/94 




Lewis G. Baker v. Crime Control & Public Safety, Office Adj. General 


94 OSP 0572 


Mann 


07/12/94 




William Smith v. State Highway Patrol 


94 OSP 0816 


Morrison 


09/09/94 




Delores Y. Bryant v. Crime Control & Public Safety 


94 OSP 0986 


Gray 


12/14/94 




Dorothea Dix Hospital 










Bettie Louise Boykin v. Dorothea Dix Hospital 


94 OSP 0831 


Nesnow 


09/28/94 




Ernest Akpaka v. Scott Stephens, Dorothea Dix Hospital 


94 OSP 0962 


Gray 


11/01/94 




Durham County Health Department 










Lylla Denell Stockton v. Durham County Health Department 


93 OSP 1780 


Gray 


05/25/94 




East Carolina School of Medicine 










Gloria Dianne Burroughs v. ECU School of Medicine 


93 OSP 0909 


Bee ton 


10/26/94 




Lillie Mercer Atkinson v. ECU, Dept of Comp. Med., 


94 OSP 0162 


Gray 


10/06/94 




Dr. William H. Pryor Jr., Sheila Church 










Wtlliam Lee Perkins v. ECU Sch of Med. Comp. Med. L. Blankenship, 


94 OSP 0741 


West 


09/30/94 




Tammy Barnes, Wm Pyroe 










East Carolina University 










Lois Toler Wilson v. East Carolina University 


94 OSP 0143 


Gray 


12/06/94 


9:19 NCR 1591 


Elizabeth City State University 










James Charles Knox v. Elizabeth City State University 


94 OSP 0207 


Gray 


06/17/94 




Employment Security Commission of North Carolina 










Dan G. Smith v. Employment Security Commission of N.C. 


93 OSP 0865 


Bee ton 


11/23/94 




Rejeanne B. LeFrancois v. Employment Security Commission of N.C. 


93 OSP 1069 


West 


04/08/94 




Department of Environment, Health, and Natural Resources 










Steven P. Karasinski v. Environment, Health, and Natural Resources 


93 OSP 0940 


West 


09/02/94 




Division of Marine Fisheries 










William D. Nicely v. Environment, Health, & Natural Resources 


92 OSP 1454 


Bee ton 


05/04/94 


9:5 NCR 333 


Fayetteviue State University 










Bessie Carpenter Locus v. Fayetteville State University 


86 OSP 0202 


Morrison 


11/18/94 


9:18 NCR 1500 


Roscoe L. Williams v. Fayetteville State University 


93 OSP 0487 


West 


06/22/94 




Department of Human Resources 










Inez Latta v. Department of Human Resources 


93 OSP 0830 


Bee ton 


03/28/94 




Charla S. Davis v. Department of Human Resources 


93 OSP 1762 


Gray 


03/03/94 




Rose Mary Taylor v. Department of Human Resources, Murdoch Center 


93 OSP 0047 


Gray 


05/06/94 




David R. Rodgers v. Jimmy Summerville, Stonewall Jackson School 


94 OSP 0087 


Chess 


03/16/94 




Dr. Patricia Sokol v. James B. Hunt, Governor and Human Resources 


94 OSP 0357 


Chess 


08/22/94 




Bruce B. Blackmon, M.D. v. DHR, Disability Determination Services 


94 OSP 0410 


Nesnow 


09/14/94 




9:21 NORTH CAROLINA REGISTER 


February 


1, 1995 


1871 



CONTESTED CASE DECISIONS 










CASE 




DATE OF 


PUBLISHED DECISIOIS 




AGENCY 


NUMBER 


ALJ 


DECISION 


REGISTER CITATION 




Craven County Department of Social Services 












Shirley A. Holland v. Craven Cty. Dept. /Social Services & Craven Cty. 


93 OSP 1606 


Gray 


07/01/94 






Nettie Jane Godwin (Lawhorn) v. Craven Cry. DSS & Craven Cty. 


93 OSP 1607 


Gray 


07/18/94 


9:9 NCR 655 




Violet P. Kelly v. Craven Cty. Dept. of Social Services & Craven Cty. 


93 OSP 1805 


Reilly 


07/05/94 






June Carol Jerkins v. Craven County Department of Social Services 


94 OSP 0758 


Nesnow 


01/11/95 






Durham County Department of Social Services 












Belinda F. Jones v. Daniel Hudgins, Durham Cty Dept of Social Svcs 


93 OSP 0728 


Chess 


04/11/94 






Ralph A. Williams v. Durham County Department of Social Services 


94 OSP 0167 


Reilly 


09/13/94 






Haywood County Department of Social Services 












Dorothy Morrow v. Haywood County Department of Social Services 


94 OSP 0186 


West 


06/17/94 






Pamlico County Department of Social Services 












Mrs. Dietra C. Jones v. Pamlico Department of Social Services 


94 OSP 0251 


Chess 


08/09/94 






Lee County Health Department 












James Shackleton v. Lee County Health Department 


94 OSP 0344 


Gray 


08/17/94 






Lenoir County Health Department 












Nino A. Coley v. Lenoir County Health Department 


94 OSP 0503 


West 


01/13/95 






Medical Assistance 












Delores Y. Bryant v. DHR, Division of Medical Assistance 


94 OSP 0991 


Gray 


10/27/94 






Delores Y. Bryant v. DHR, Division of Medical Assistance 


94 OSP 0992 


Gray 


10/27/94 






Mental Health/Mental Retardation 












Yvonne G. Johnson v. Blue Ridge Mental Health 


93 OSP 1604 


Bee ton 


03/18/94 






Services for the Blind 












Donna L. Williams v. DHR, Division of Services for the Blind 


93 OSP 1610 


Morrison 


10/25/94 






\\bke County Mental Health, Developmental Disabilities, and Substance Abuse Services 










Julia Morgan Brannon v. Wake County MH/DD/SAS 


94 OSP 0214 


Reilly 


04/14/94 






vMryne County Department of Social Senices 












Brently Jean Carr, Nancy Carol Carter v. Wayne County/Wayne 


94 OSP 0539** 


Mann 


11/07/94 






County Department of Social Services 












Brently Jean Carr, Nancy Carol Carter v. Wayne County/Wayne 


94 OSP 0540* 


Mann 


11/07/94 






County Department of Social Services 












Youth Services 












David R. Rodgers v. DHR, Div./Youth Services, Stonewall Jackson Sch. 


94 OSP 0306 


Chess 


10/24/94 






Justice 












Delores Y. Bryant v. Department of Justice 


94 OSP 0984 


Gray 


10/27/94 






Public Instruction 












Elaine M. Sills v. Department of Public Instruction 


94 OSP 0781 


Gray 


10/06/94 






Delores Y Bryant v. Department of Public Instruction 


94 OSP 0981 


Gray 


11/28/94 






Delores Y. Bryant v. Department of Public Instruction 


94 OSP 0982 


Gray 


11/28/94 






1872 NORTH CAROLINA REGISTER 


February 1, 


1995 9:2j 





CONTESTED CASE DECISIONS 










CASE 




DATE OF 


PUBLISHED DECISION 


AGENCY 


NUMBER 


ALJ 


DECISION 


REGISTER CITATION 


Real Estate Appraisal Board 












Earl Hansford Grubbs v. Appraisal Board 


94 OSP 0753 


Nesnow 


08/24/94 






Smoky Mountain Center 












Betty C. Bradley v. Smoky Mountain Center 


93 OSP 1505 


Bee ton 


09/26/94 


9:14 NCR 


1141 


N.C. State University 












Laura K. Reynolds v. N.C. State University - Dept. of Public Safety 


92 OSP 0828 


Morgan 


05/26/94 






Ashraf G. Khalil v. N.C.S.U. 


93 OSP 1666 


Nesnow 


09/19/94 






Robin Lazenty Boyd v. NC State University Human Res. /Seafood Lab 


94 OSP 0779 


Nesnow 


12/01/94 






Department of Transportation 












Phyllis W. Newnam v. Department of Transportation 


92 OSP 1799 


Morgan 


08/11/94 






Glenn I. Hodge Jr. v. Samuel Hunt, Sec'y. Dept. of Transportation 


93 OSP 0297* 1 


Morrison 


03/10/94 


9:1 NCR 


60 


Glenn I. Hodge Jr. v. Samuel Hunt, Sec'y. Dept. of Transportation 


93 OSP 0500* 1 


Morrison 


03/10/94 


9:1 NCR 


60 


Betsy Johnston Powell v. Department of Transportation 


93 OSP 0550 


Morrison 


03/28/94 






Arnold Craig v. Samuel Hunt, Secretary Department of Transportation 


93 OSP 0586 


Nesnow 


07/11/94 






Susan H. Cole v. Department of Transportation, Div. of Motor Vehicles 


93 OSP 0908 


Morrison 


07/15/94 






Susan H. Cole v. Department of Transporfation, Div. of Motor Vehicles 


93 OSP 0908 


Morrison 


10/07/94 






Clyde Lem Hairston v. Department of Transporfation 


93 OSP 0944 


Chess 


02/28/94 






Angela Trueblood Westmoreland v. Department of Transporfation 


93 OSP 1001 


Morrison 


09/30/94 


9:14 NCR 


1136 


Bobby R. Mayo v. Department of Transportation 


93 OSP 1004 


Nesnow 


09/01/94 






Tony Lee Curtis v. Department of Transportation 


93 OSP 1037 


Reilly 


08/26/94 






Darrell H. Wise v. Department of Transportation 


93 OSP 1353 


Gray 


07/26/94 






Henry C. Puegh v. Department of Transportation 


93 OSP 1710 


Nesnow 


05/24/94 






Kenneth Ray Harvey v. Department of Transportation 


94 OSP 0423 


Morrison 


08/17/94 






Jean Williams v. Department of Transporfation 


94 OSP 0502 


Morrison 


11/22/94 


9:18 NCR 


1504 


R. Stanley Morgan v. Department of Transporfation 


94 OSP 0586** 


Reilly 


12/13/94 






Bobby R. Mayo v. Department of Transporfation 


94 OSP 0632 


Gray 


08/23/94 






A. Dean Bridges v. Department of Transportation 


94 OSP 0654** 


Reilly 


12/13/94 






Michael Bryant v. Department of Transportation 


94 OSP 0728 


Chess 


08/15/94 






Pearlie M. Simue I- Johnson v. Department of Transporfation 


94 OSP 0844 


Gray 


11/14/94 






Freddie R. Lewis, Jr. v. Department of Transportation 


94 OSP 1023 


Reilly 


01/04/95 






University of North Carolina at Chapel Hill 












William faul Fearrington v. University of North Carolina at Chapel Hill 


91 OSP 0905 


Reilly 


10/19/94 






laulette M. McKoy v. University of North Carolina at Chapel Hill 


92 OSP 0380* 7 


Bee ton 


10/24/94 






Paulette M. McKoy v. University of North Carolina at Chapel Hill 


92 OSP 0792* 7 


Becton 


10/24/94 






Eric W. Browning v. UNC-Chapel Hill 


93 OSP 0925 


Morrison 


05/03/94 


9:5 NCR 


342 


Beth Anne Miller R.N.-C v. UNC James A. Taylor Std Health Svc. 


94 OSP 0800 


Nesnow 


09/26/94 






University of North Carolina at Greensboro 












James S. Wilkinson v. UNCG Police Agency 


93 OSP 0850 


Chess 


08/22/94 






UNC Hospitals 












Barry Alonzo Nichols v. UNC Hospitals Central Dist. Sect. 


94 OSP 0509 


Morrison 


06/15/94 






Wake County School System 












Lula Mae Freeman v. Wake County School System 


94 OSP 0576 


Morrison 


06/28/94 






The Whitaker School 












Dwayne R. Cooke v. The Whitaker School 


94 OSP 0328 


Chess 


06/02/94 






Winston-Salem State University 












David Phillip Davis v. Winston-Salem State University 


93 OSP 0947 


Reilly 


09/28/94 






Tonny M. Jarrett v. Winston-Salem State University Campus Police 


93 OSP 0953 


Reilly 


09/12/94 






9:21 NORTH CAROLINA REGISTER 


February 


1, 1995 




1873 



CONTESTED CASE DECISIONS 



CASE 
NUMBER 



AGENCY 



STATE TREASURER 

Retirement Systems Diiision 

Molly Wiebenson v. Bd./TrusteesATeachers' &. State Employees' Ret. Sys. 
Judith A. Dorman v. Bd./TrusteesrTeachem' & State Employees' Ret. Sys. 
Nathan Fields v. Bd./Tnistees/Teachers' &. State Employees' Ret. Sys. 
John C. Russell v. Bd./Trustees/TeacheiB' & State Employees' Ret. Sys. 
Marion Franklin Howell v. Teachers' & State Employees' Retirement Sys. 
Robert A. Slade v. Bd.ATrustees/N.C. Local Govtl. Emp. Ret. System 
Connie B. Grant v. Bd./Trustees/TeacheiB' & State Employees' Ret. Sys. 
James E. Walker, Ind. & Admin for the Estate of Sarah S. Walker v. Bd./ 

Trustees/N.C. Local Govt. Emp. Ret. System 
Elizabeth M. Dudley v. Bd. /Trustees/Teachers' & State Emps' Ret. Sys. 
Kenneth A. Glenn v. Bd./TrusteesATeachers' &. St Employees' Ret. Sys. 
Joseph Fulton v. Bd. /Trustees/Teaches' & State Employees' Ret. Sys. 
Deborah W. Stewart v. Bd. /Trustees/Teachers' & State Employees' 

Ret. Sys. and Anthony L. Hope & Derrick L. Hope 

TRANSPORTATION 



Taylor & Murphy Construction Co. , Inc. v. Department of Transportation 93 DOT 1404 
U.S. EQUAL EMPLOYMENT OPPORTUNITY COMMISSION 

Robert Tolbert v. U.S. Equal Employment Opportunity Commission 94 USE 1410 

UNIVERSITY OF NORTH CAROLINA 



ALJ 



DATE OF 
DECISION 



PUBLISHED DECISION 
REGISTER CITATION 



92 DST 0015 


Morgan 


05/26/94 


9:6 NCR 


403 


92 DST 0223 


Morgan 


08/11/94 






93 DST 0161 


Morrison 


05/18/94 






93 DST 0164 


West 


03/07/94 






93 DST 0475 


Nesnow 


08/04/94 


9:12 NCR 


941 


93 DST 0785 


Bee ton 


03/18/94 


9:1 NCR 


68 


93 DST 0883 


Chess 


06/15/94 






93 DST 1054 


Bee ton 


05/31/94 


9:7 NCR 


490 


93 DST 1474 


Nesnow 


03/28/94 






93 DST 1612 


Morrison 


05/18/94 






93 DST 1731 


Bee ton 


05/25/94 






94 DST 0045 


Nesnow 


07/25/94 


9:10 NCR 


768 



Heather Anne Ftarter v. State Residence Committee 
Nixon Omolodun v. UNC Physicians and Associates 



92 UNC 0799 
94 UNC 0295 



Chess 08/24/94 



Gray 12/14/94 



Nesnow 08/23/94 

Chess 06/27/94 



1874 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CONTESTED CASE DECISIONS 



STATE OF NORTH CAROLINA 



COUNTY OF GUILFORD 



IN THE OFFICE OF 

ADMINISTRATIVE HEARINGS 

93 OSP 1694 



PEGGY L. CANTRELL, 
Petitioner, 



N.C A&T STATE UNIVERSITY, 
Respondent. 



RECOMMENDED DECISION 



This matter came on for hearing before the undersigned administrative law judge on April 26 and 27 
and July 25 and 26, 1994, in Greensboro. 

J. Sam Johnson, Jr. represented the petitioner. Anne J. Brown represented the respondent. The 
petitioner testified and introduced Exh. #1, 2, 3 and 4. The respondent presented fourteen witnesses and 
introduced Exh. #7, 12, 15, 16, 17, 18, 19, 20, 21, 23, 24, 25, 25A, 29, 32, 34, 35, 36, 39, 40 and 41. The 
petitioner filed a Written Argument on September 19, 1994. Due to delay in preparing the transcript, the 
respondent was not able to file Proposed Findings of Fact until December 29, 1994. 

ISSUES 

1. Did the respondent have just cause to dismiss the petitioner? 

2. Did the respondent, in dismissing the petitioner, discriminate and retaliate against her on the basis 
of race? 

FINDINGS OF FACT 

1 . The petitioner, a white woman and registered nurse, was employed as a staff nurse in the Sebastian 
Health Center from 1977 until November 3, 1993. She was the only white nurse. 

2. The petitioner received the following disciplinary warnings: 

Verbal warning, August 18, 1987 
Written warning, January 16, 1987 
Written warning, November 23, 1988 
Final written warning, March 28, 1990 
Written warning, August 2, 1990 
Written warning, November 5, 1992 
Verbal warning, April 5, 1993 
Final warning, May 19, 1993 
Written warning, October 21, 1993 

3. During a conference on November 3, 1993, Linda Bowling, a black woman and the petitioner's 
supervisor, asked the petitioner whether she had destroyed the original assessment form of Angela 
Thomas, a student and employee of Taco Bell who had come to the health center for treatment for 
a cut on her hand. She further asked whether the petitioner understood the proper way to make a 
change in a medical record. Ms. Bowling handed the petitioner an excerpt from a reference book 
maintained in the department that explained how to correct errors and make changes in medical 



9:21 



NORTH CAROLINA REGISTER 



February 1, 1995 



1875 



CONTESTED CASE DECISIONS 






records. The petitioner had replaced the original form with another. The petitioner had not been tolc 
to destroy the original form which Dr. Flotilla Watkins had signed. 

4. The petitioner admitted that she destroyed Ms. Thomas' original assessment form and then prepared 
another form to correct her errors on the first form. Ms. Bowling then informed the petitioner that 
a predismissal conference was being conducted. No advance notice of the conference or the reasons 
for the conference was given. The petitioner had noticed a security guard outside of Ms. Bowling's 
office when she entered. She had been summoned to the office upon reporting for work. Dr. James 
Sibert was in the office with Ms. Bowling. Dr. Sibert and Ms. Bowling did not confer to consider 
the petitioner's responses. Rather, Ms. Bowling concluded the predismissal conference by stating: 

Considering the fact that you destroyed this chart, this old assessment form, I have no other 
recourse but to fire you. (T p 189, Vol. Ill) 

After the conference, the security guard took the petitioner by the arm and escorted her to her car. 

5. A dismissal letter was issued on the same day. The letter gave the following reasons for dismissal: 

Personal conduct as it relates to your removal of and/or destruction of and/or falsification of 

medical records relating to the visit of Angela Thomas in the Health Center on October 20, 

1993. 

For compromising the integrity of this student's medical records. 

6. The petitioner did not falsify any medical records. The integrity of Ms. Thomas' medical record was 
compromised in that destruction of the original assessment form creates uncertainty about what care 
had been administered to Ms. Thomas. 

7. The petitioner had received training at the health center concerning the proper way to correct an error 
in a medical record. A copy of the nursing policy and procedure relating to charting and 
documentation is maintained at the nurses desk at the Sebastian Health Center. "The person 
correcting a charting error should cross out the incorrect entry, enter the correct information, initial 
the correction and enter the time and date the correction was made. . . ." R Exh. 34, p 1 

8. Clara Smith, an expert in the field of nursing testified that, in her opinion, a registered nurse should 
know that it is improper to destroy a patient's medical record. 

9. Ms. Bowling did not make the comment, "I don't know why with so many good black nurses, we 
have a white nurse on the staff. " 

10. The petitioner's shift assignment was not changed because of race, as alleged by the petitioner, but 
rather as a result of an incident for which petitioner received a final written warning. The petitioner's 
shift assignment was changed to the day shift in order for her to receive close supervision in 
performing assessments. 

1 1 . Ms. Bowling did not retaliate against the petitioner by not allowing her to go on a retreat. Rather, 
she made arrangements for the petitioner to attend the retreat. The petitioner decided not to attend 
the retreat. 

CONCLUSIONS OF LAW 

1. The petitioner was a permanent State employee at the time of her dismissal. 

2. "(N)o permanent employee subject to the State Personnel Act shall be dismissed, except for just 
cause." See G.S. 126-35. Just cause may be substantive or procedural. Substantive just cause falls 
into two categories: 



1876 NORTH CAROLINA REGISTER February 1, 1995 9:21 



CONTESTED CASE DECISIONS 



(1) causes relating to performance of duties (prior warnings are required); and 

(2) causes relating to personal conduct detrimental to State service (no prior warnings are 
required) . 

3. In Jones v. Department of Human Resources , 300 NC 687, 690-691, 268 SE2d 500, 502 (1980), the 
Supreme Court of North Carolina held that "(p)rior to dismissal for causes relating to performance 
of duties, a permanent State employee is entitled to three separate warnings that his performance is 
unsatisfactory. " 

4. The respondent had substantive just cause to dismiss the petitioner. The just cause related to 
performance of duty, i.e. the failure to properly correct errors in medical records. The petitioner had 
received the required prior warnings. The petitioner did not engage in conduct detrimental to State 
service. Although the dismissal letter characterized the reason as personal conduct, the evidence 
establishes both the required prior warnings and deficiencies in job performance. 

5. The petitioner has failed to establish that she was terminated from employment because of her race 
and that she was retaliated against for complaining about discrimination. 

6. The predismissal conference did not comply with 25 NCAC U .0606. The respondent violated the 
petitioner's procedural due process rights which include an opportunity to present her position in a 
meaningful time and manner. Dr. Sibert and Ms. Bowling had decided to dismiss the petitioner 
before the predismissal, conference. Although the issue involved record-keeping, a guard was posted 
at the office door for the purpose of escorting the petitioner to her car after she was dismissed. 

The petitioner is entitled to an award of back pay from the date of the dismissal (November 3, 1993) 
through the date of the hearing (July 26, 1994). The petitioner is also entitled to an award of 
attorney's fees. See 25 NCAC IB .0432(c) and G.S. 126-4(11). See also Bishop v. Department of 
Human Resources , 100 NC App 175, 394 SE2d 702 (1990), disc, rev, improvidentlv allowed , 328 
NC 325, 401 SE2d 366 (1991). 

RECOMMENDED DECISION 

It is recommended that the petitioner's dismissal be upheld but that the petitioner be awarded back 
pay and attorney's fees for the procedural violations. 

NOTICE 

The parties have the right to file exceptions and to present written arguments to the State Personnel 
Commission. The final decision in this contested case shall be made by that agency. The agency will mail 
a copy of the final decision to the parties and the Office of Administrative Hearings. 

This the 6th day of January, 1995. 



Robert Roosevelt Reilly Jr. 
Administrative Law Judge 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1877 





NORTH CAROLINA ADMINISTRATIVE CODE CLASSIFICATION SYSTEM 




1 he North Carolina Administrative Code (NCAC) has four major subdivisions of rules. Two 


of these, 


titles and chapters, are mandatory. The major subdivision of the NCAC is the title. Each major 


department in the North Carolina executive 


branch of government has been assigned a title number. 


Titles are further broken down into chapters which shall be numerical in order. The other two, 


subchapters and sections are optional subdivisions to be used by agencies when appropriate. 




TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE 


TITLE DEPARTMENT 


LICENSING BOARDS 


CHAPTER 


1 


Administration 


Acupuncture 


1 


2 


Agriculture 


Architecture 


2 


3 


Auditor 


Auctioneers 


4 


4 


Commerce 


Barber Examiners 


6 


5 


Correction 


Certified Public Accountant Examiners 


8 


6 


Council of State 


Chiropractic Examiners 


10 


7 


Cultural Resources 


General Contractors 


12 


8 


Elections 


Cosmetic Art Examiners 


14 


9 


Governor 


Dental Examiners 


16 


10 


Human Resources 


Dietetics/Nutrition 


17 


11 


Insurance 


Electrical Contractors 


18 


12 


Justice 


Electrolysis 


19 


13 


Labor 


Foresters 


20 


14A 


Crime Control & Public Safety 


Geologists 


21 


15A 


Environment, Health, and Natural 


Hearing Aid Dealers and Fitters 


22 




Resources 


Landscape Architects 


26 


16 


Public Education 


Landscape Contractors 


28 


17 


Revenue 


Marital and Family Therapy 


31 


18 


Secretary of State 


Medical Examiners 


32 


19A 


Transportation 


Midwifery Joint Committee 


33 


20 


Treasurer 


Mortuary Science 


34 


*21 


Occupational Licensing Boards 


Nursing 


36 


22 


Administrative Procedures 


Nursing Home Administrators 


37 


23 


Community Colleges 


Occupational Therapists 


38 


24 


Independent Agencies 


Opticians 


40 


25 


State Personnel 


Optometry 


42 


26 


Administrative Hearings 


Osteopathic Examination & Reg. (Repealed) 


44 






Pharmacy 


46 






Physical Therapy Examiners 


48 






Plumbing, Heating & Fire Sprinkler Contractors 


50 






Podiatry Examiners 


52 






Professional Counselors 


53 






Practicing Psychologists 


54 






Professional Engineers & Land Surveyors 


56 






Real Estate Appraisal Board 


57 






Real Estate Commission 


58 






Refrigeration Examiners 


60 






Sanitarian Examiners 


62 






Social Work Certification 


63 






Speech & Language Pathologists & Audiologists 


64 






Therapeutic Recreation Certification 


65 






Veterinary Medical Board 


66 



Note: Title 21 contains the chapters of the various occupational licensing boards. 



1878 



NORTH CAROLINA REGISTER 



February 1, 1995 



9:21 



CUMULATIVE INDEX 



CUMULATIVE INDEX 

(April 1994 - March 1995) 

Pages Issue 

1 - 75 1 - April 

76 - 122 2 - April 

123 - 226 3 - May 

227 - 305 4 - May 

306 - 348 5 - June 

349 - 411 6 - June 

412 - 503 7 - July 

504 - 587 8 - July 

588 - 666 9 - August 

667 - 779 10 - August 

780 - 876 11 - September 

877 - 956 12 - September 

957 - 1062 13 - October 

1063 - 1151 14 - October 

1152 - 1241 15 - November 

1242 - 1339 16 - November 

1340 - 1392 17 - December 

1393 - 1512 18 - December 

1513 - 1602 19 - January 

1603 - 1696 20 - January 

1697 - 1882 21 - February 



Unless otherwise identified, page references in this Index are to proposed rules. 



ADMINISTRATION 

State Employees Combined Campaign, 878 

ADMINISTRATIVE HEARINGS 

Rules Division, 1663 

AGRICULTURE 

Plant Industry, 127, 1245 

COMMERCE 

Alcoholic Beverage Control Commission, 423 
Banking Commission, 884, 1515, 1701 
Community Assistance, 1394 
Energy Division, 4 

COMMUNITY COLLEGES 

Community Colleges, 1305, 1661 

CORRECTION 

Prisons, Division of, 1157 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1879 



CUMULATIVE INDEX 



CRIME CONTROL AND PUBLIC SAFETY 

State Highway Patrol, Division of, 243 

CULTURAL RESOURCES 

Arts Council, 960 

ENVIRONMENT, HEALTH, AND NATURAL RESOURCES 

Coastal Management, 443, 825, 1185, 1283, 1427, 1550 

DEM/ Air Quality, 80, 805 

Departmental Rules, 254 

Environmental Management, 81, 258, 352, 616, 959, 1261, 1348, 1405, 1639 

Health Services, 323, 370, 445, 834, 913, 1000, 1112, 1557 

Marine Fisheries Commission, 820, 989, 1109, 1244 

Mining Commission, 442 

NPDES Permit, 3, 232 

Parks and Recreation, 1194 

Radiation Protection Commission, 678 

Sedimentation Control Commission, 1648 

Soil and Water Conservation, 1371 

Solid Waste Management, 171, 364, 1287 

Water Resources, 165, 255 

Wildlife Resources Commission, 38, 42, 84, 358, 830, 910, 999, 1285, 1427, 1553, 1653, 1854 

Wildlife Resources Commission Proclamation, 125 

FINAL DECISION LETTERS 

Voting Rights Act, 2, 312, 506, 594, 958, 1243, 1340, 1393, 1700 

GENERAL STATUTES 

Chapter 150B, 780 

GOVERNOR/LT. GOVERNOR 

Executive Orders, 1, 123, 227, 306, 349, 412, 504, 588, 667, 877, 957, 1152, 1242, 1513, 1697 

HUMAN RESOURCES 

Child Day Care Commission, 10 

Child Development, 1531 

Children's Services, 136 

Day Care Rules, 148 

Departmental Rules, 668 

Facility Services, 4, 128, 423, 509, 668, 890, 1341, 1603 

Medical Assistance, 318, 440, 513, 597, 964, 1155, 1247, 1631 

Medical Care Commission, 1161, 1718 

Mental Health, Developmental Disabilities and Substance Abuse Services, 13, 24, 36, 313, 430, 961, 

1063 
Social Services, 136, 595, 802, 1167, 1343 
Vocational Rehabilitation Services, 434 

INDEPENDENT AGENCIES 

State Health Plan Purchasing Alliance Board, 99, 1030 

INSURANCE 

Actuarial Services Division, 1072, 1257, 1635 
Agent Services Division, 1065 
Consumer Services Division, 1633 



1880 NORTH CAROLINA REGISTER February 1, 1995 9:21 






CUMULATIVE INDEX 



Departmental Rules, 891, 1632 

Financial Evaluation Division, 892 

Life and Health Division, 525, 905, 1071, 1255, 1634 

Medical Database Commission, 605 

Multiple Employer Welfare Arrangements, 76 

Property and Casualty Division, 892, 1634 

Special Services Division, 76 

JUSTICE 

Alarm Systems Licensing Board, 351, 614, 804, 1175, 1853 

Criminal Justice Education and Training Standards Commission, 149, 981 

Private Protective Services, 802, 1174, 1400 

Sheriffs' Education & Training Standards Commission, 670, 986, 1075 

State Bureau of Investigation, 234, 530 

LABOR 

Boiler and Pressure Vessel, 1076 

Mine and Quarry Division, 239 

OSHA, 77, 160, 675, 906, 1258, 1401, 1546 

Private Personnel Services, 1176 

Variance, 230 

LICENSING BOARDS 

Acupuncture Licensing Board, 44 

Auctioneers Licensing Board, 836 

Barber Examiners, 563 

Chiropractic Examiners, 376 

Cosmetic Art Examiners, 280, 1027 

Dietetics/Nutrition, 1115 

Electrical Contractors Examiners, 1199 

Electrolysis Examiners, 1204 

General Contractors, 1658 

Landscape Architects, Board of, 95 

Medical Examiners, 192, 565, 1119, 1206 

Mortuary Science, 720, 1120 

Nursing, Board of, 45, 724, 1209 

Opticians, Board of, 845 

Optometry, Board of Examiners, 194, 1660 

Physical Therapy Examiners, 566 

Plumbing, Heating and Fire Sprinkler Contractors, Board of, 96, 725 

Practicing Psychologists, Board of, 97, 1571 

Professional Counselors, Board of Licensed, 50 

Professional Engineers and Land Surveyors, 728, 924 

Sanitarian Examiners, 730 

LIST OF RULES CODIFIED 

List of Rules Codified, 53, 196, 281, 378, 635, 742, 926, 1041, 1306, 1480, 1666 

PUBLIC EDUCATION 

Elementary and Secondary Education, 375, 540, 920, 1197, 1568 

SECRETARY OF STATE 

Land Records Management Division, 712 
Notary Public Division, 1112 
Securities Division, 476, 616, 709 



9:21 NORTH CAROLINA REGISTER February 1, 1995 1881 



CUMULATIVE INDEX 



STATE PERSONNEL 

Office of State Personnel, 477, 847, 1214, 1574 



TAX REVIEW BOARD 

Orders of Tax Review, 415 

TRANSPORTATION 

Administration, Director of, 1478 
Highways, Division of, 85, 718, 923, 1114, 1300 
Motor Vehicles, Division of, 89, 276, 542 
Secretary of Transportation, 1658 



1882 NORTH CAROLINA REGISTER February 1, 1995 9:21 



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